MelissaBPhD's podcast

Melissa B PhD

In today's busy society, people aren't typically thinking about aging or elder care. By 2030, there will be more older adults than children under age 5 for the first time in human history. Here's a fantastic podcast with different topics ranging from clinical care of older adults to things that family caregivers need to know. Hosted by Dr. Melissa Batchelor (MelissaBPhD) 'This Is Getting Old' highlights all of the things we need to do to create an age-friendly world - because when things are age-friendly, they are friendly for everyone.

All Episodes

Typically, around 85% of people will experience swallowing problems medically known as dysphasia at the end of life. Your loved ones or the people you care for can have trouble swallowing food, liquids, or both.  This is a 4-part series on Alzheimer's Care and Swallowing Problems, and this episode is focused on Maximizing Independence In Eating.            In Part 1, I talked about The Basics of Swallowing Problems.             In Part 2, Modifying Textures + Flavor Building            and Part 3, Adaptive Equipment. If you missed an episode, you can check them out where you found this one – or on my YouTube Channel, MelissaBPhD.  ✔️ Main Point 1: Basics of Offering Feeding Assistance Sit with the person during meals  Eat together if possible Make eye contact Offer verbal, visual, and sensorimotor cues Offer small amounts of food at a slow, consistent rate    ✔️ Main Point 2: Maximize independence for Self-Feeding Verbal and Visual Cues NOSH adds Sensorimotor Cue with Handfeeding Techniques Use of finger foods if utensils are hard to manage: – Best for Regular and Mechanical Soft Diets Sandwiches Ice Cream Frozen yogurts Chicken nuggets ✔️ Main Point 3: Handfeeding Techniques: Developed for persons living with Alzheimer's Disease, but can be used for other difficulties Limited range of motion in upper arm, elbows, shoulder Tremors Limited dexterity of hands, fingers Arm weakness Lack of endurance to self-feed for an entire meal Main Point 4: General Guidelines for How and When To Use Each Handfeeding Technique Sit on the dominant side of the person you are assisting Tailor amount of support to their ability in the moment Promote self-feeding as much as possible To assist: – Start with Over Hand,  – then Under Hand,  – And Save Direct Hand for those who are totally dependent Many people in my studies had not fed themselves for a year or two. When we started using the handfeeding techniques with them -- many started feeding themselves again.    Visit https://melissabphd.com/nosh__courses/ for videos demonstrating the different handfeeding techniques. If you have questions, comments, or need help, please feel free to drop a one-minute audio or video clip and email it to me at melissabphd@gmail.com, and I will get back to you by recording an answer to your question. About Melissa Batchelor, Ph.D., RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.  

Nov 30

7 min 53 sec

Typically, around 85% of people will experience swallowing problems medically known as dysphasia at the end of life. Your loved ones or the people you care for can have trouble swallowing food, liquids, or both.  This is a 4-part series on Alzheimer's Care and Swallowing Problems, and this episode is focused on Adaptive Equipment. In Part 1, I talked about The Basics of Swallowing Problems.  In Part 2, Modifying Textures + Flavor Building  and Part 4, Maximizing Independence In Eating. If you missed an episode, you can check them out where you found this one – or on my YouTube Channel, MelissaBPhD.  ✔️ Main Point 1: Selecting Adaptive Feeding Devices: Considerations     What is the underlying issue?          – Limited range of motion          – Dexterity limitations          – Improving ease of self-feeding          – Reducing spillage          – Swallowing problems ✔️  Main Point 2: Non-skid/ Non-slip mats       -Nonskid and non-slip mats are really good for holding not just dishes.       -You can put these on a wheelchair seat to prevent that from sliding out.       -Use them on the bedside table if they need to get to a cup.   -Use those sticky little square things and put them around toothbrush   handles or maybe a razor so that the person has a bigger grip.  ✔️  Main Point 3: Cups/ Mugs        -Cups that have a weight in the base are perfect for preventing spills.       - Use a cup with a wider base so that it's easier for them to set it down           - A closed handle cup is also recommended     - If the patient has too much of a tremor, find them a cup with an open  handle        -Nosey Cups are practical so that when you drink from the regular side of the cup and tip it up, there's a spot for the nose, so you don't have to hyperextend your neck.       -Talking about lids, you could have a long spout type or short spout, and that also could have a straw hole that helps control the flow of the liquid and prevent splashing or spilling.  ✔️ Main Point 4: Plate Guards     -Partitioned plates have compartments and give an edge so that you can scoop each of those food items separately.       -A scoop bowl or a dish with a high curved rim on one side is helpful so that  the patient can use the utensil and it's lower on one side to get into the bowl and then scoop the other side.     -You can modify plates and either buy the plate with the plate guard on it, or you can buy pieces that clip onto your existing plates.  ✔️ Main Point 5: Utensils -The added weight on the end of the utensil's handle helps stabilize somebody's hand if they have a tremor or weak grip strength. -Coated spoons are not recommended for Alzheimer's patients who bite on the utensil every time you put it in their mouth. -Bendable utensils help maximize the person's ability to feed themselves if they have a limited range of motion.  -Put a strap on the utensil so it might be like a Velcro hook or has a loop closure.  -Utensil tubing lets you put it on the end of any handle and objects more than just utensils. You could put it on the end of a razor or a toothbrush.  If you have questions, comments, or need help, please feel free to drop a one-minute audio or video clip and email it to me at melissabphd@gmail.com, and I will get back to you by recording an answer to your question.  About Melissa Batchelor, Ph.D., RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/

Nov 23

11 min

Typically, around 85% of people will experience swallowing problems medically known as dysphasia at the end of life. Your loved ones or the people you care for can have trouble swallowing food, liquids, or both.  This is a 4-part series on Alzheimer’s Care and Swallowing Problems, and this episode is focused on Modifying Textures + Flavor Building.  In Part 1, I talked about The Basics of Swallowing Problems.  In Part 3, I will review what Adaptive Equipment is and how to use it; and In Part 4, I will talk about how to maximize independence in eating. If you missed an episode, you can check them out where you found this one – or on my YouTube Channel, MelissaBPhD.  Main Point #1 - How to choose recipes that can be adapted for a variety of textures Intergenerational considerations Ease of recipe Modifiable textures Main Point #2 - Kitchen Items to Help Prepare Foods Blender The Magic Bullet® or Nutribullet®  Hand-held Blender (Immersion Blender) Food Processor Household Mesh Strainer or Sieve Baby Food Grinder   Main Point #3 - Tips for Flavor building when modifying textures for meals Use Fats, Dairy, or Vegetables to build flavor. - Butter - Margarine - Sour Cream  - Pureed Cottage Cheese - Cooking fats - Oils - Gravies - Whipped toppings  - Heavy cream - Mashed or blended avocado - Hummus Liquids to make foods easier to swallow, such as:  - Broth - Milk - Fruit Juices  - Vegetable Juices - Water   If you have questions, comments, or need help, please feel free to drop a one-minute audio or video clip and email it to me at melissabphd@gmail.com, and I will get back to you by recording an answer to your question.  About Melissa Batchelor, Ph.D., RN, FNP-BC, FGSA, FAAN:   I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Nov 16

6 min 21 sec

Alzheimer's Disease Care: Swallowing Problems Part I: The Basics with Melissa Batchelor   Typically, around 85% of people will experience swallowing problems, medically known as dysphasia, at the end-of-life. What this means is that your loved one, or someone you care for, has trouble swallowing food, liquids, or both.    This is a 4-part series on Alzheimer's Care and Swallowing Problems, and this episode is focused on The Basics.          In Part 2, I will talk about how to Modify Textures + Flavor  Building.  In Part 3, I will review what Adaptive Equipment is and how to use it; and in  In Part 4, I will talk about Maximizing Independence in Eating.   If you missed an episode, you can check them out where you found this one – or on my YouTube Channel, MelissaBPhD.  ✔️ MAIN POINT 1: WHAT IS A SWALLOWING PROBLEM   What is Dysphagia? Some people will have trouble swallowing certain foods or liquids;      others can't swallow at all Signs of dysphagia – Coughing or choking when eating or drinking – Bringing food back up, sometimes through the nose – A sensation that food is stuck in your throat or chest – Persistent drooling of saliva   Complications of Dysphagia: Malnutrition  Dehydration Aspiration Pneumonia   Treating Dysphagia: Speech-Language Therapy to learn new swallowing techniques Change consistency of food and fluids to make them safer to swallow Alternative forms of feeding – Tube Feeding or Handfeeding   ✔️  MAIN POINT 2: SWALLOWING PROBLEMS: WHO, WHAT, AND WHY  ▪      Demographics ▪ Estimated that 9 million Americans experience difficulty swallowing ▪ 1 in 5 older adults; 40% of those living in nursing homes or assisted living facilities ▪ Alzheimer's Disease: 80%  ▪ Parkinson's Disease: 60%   ▪  Underlying Health or Chronic Conditions Nervous System ▪ Stroke, Head Injury, Parkinson's Disease or Dementia Cancer  ▪ Mouth or Throat Cancer Gastroesophageal Reflux Disorder (GERD) Other Conditions: ▪ Trouble with swallowing or chewing ▪ Have trouble moving or have lost feeling in parts of your mouth, such as lips or tongue ▪ Tooth pain; Missing teeth   ▪  Psychosocial Considerations ▪ Impaired social and psychological well-being ▪ Increased worry about choking in front of others ▪ Caregiver fear/ anxiety ▪ Caregiver burnout in managing the needs of unfamiliar disease ▪ Lack of comprehensive guidelines for the management of dysphagia in older adults.   ✔️ MAIN POINT 3: LEARNING THE LINGO TO ADAPT FOOD AND FLUIDS    Diet Consistencies: Regular Diet Mechanical Soft Diet – These foods require less chewing than foods on a regular diet. – Foods may require different textures and thicknesses, such as chopped, ground, or pureed foods Pureed Diet – Minced, Pureed, or Liquidized Foods don't require chewing, such as mashed potatoes or pudding Can also blend or stain other foods to make them smoother Liquids, such as broth, milk, juice or water, may be added to foods to make them easier to swallow.   Liquid Consistencies: Pudding Thick (Extremely thick) Honey Thick (Moderately thick) Nectar Thick (Mildly Thick) Thin (Slightly thin)   If you have questions, comments, or need help, please feel free to drop a one-minute audio or video clip and email it to me at melissabphd@gmail.com, and I will get back to you by recording an answer to your question.  About Melissa Batchelor, Ph.D., RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Oct 30

8 min 5 sec

How do you feel about becoming older? Do you see it as a rite of passage or a dreaded occurrence that you must endure? As we become older, "health" means more than simply being free of illnesses. Every older person may achieve "positive aging," also known as "healthy aging," if they strive to make better alternatives to improve their life in the long run. Dr. David Lereah, PhD, is one of the few who fully grasps this concept. Thus, don’t miss another life-changing episode of This Is Getting Old: Moving Towards An Age-Friendly World with Dr. David Lereah, PhD. Let's all take a leaf out of his book as he shares his life story, how he survived stage three esophageal cancer, and show how minor changes to your daily habits may help you enjoy your years as much as possible. Part One Of 'How to Age Well: The Power Positive Aging' The Power Positive Aging: A Potpourri Of Rich Experiences Dr. David Lereah's book, The Power Positive Aging, started from a vision of helping older adults in need combined with his cancer battle journey, his Meals on Wheels volunteering realizations, and missions from his non-profit organization United We Age.  Diagnosed with stage three esophageal cancer, Dr. David Lereah went on a journey—a terrible journey. He went through intense chemotherapy, radiation, and a seven-hour surgery.  That's where it all started for Dr. David Lereah. He looked at life-threatening diseases as an inconvenience. He researched how to cope with aging, and that's where he discovered the power of positive aging. One thing led to another, and he wrote the book—The Power Positive Aging.  "You may experience some loss in strength as a normal part of aging, but a decline in and of itself isn't normal." Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN How To Have A Positive Experience With Aging?  Personally, Dr. David Lereah discovered six building blocks for positive aging. He relates it to everyone through his book because he believes everyone is in the same boat coping with physical and mental decline as we grow old. The Six Building Blocks To Cope With Aging   Tapping With Our Spirit-We all know about our spirit, we talk about it, but we don't do anything about it. Instead, we worry about wrinkles on our face. We worry about losing our mobility. We may be physically declining, but our spirit could be strengthening. Thus, tapping into your spirit while physically declining is a significant asset and helps people confront the marks of aging.  Positivity-which is using affirmations and a lot of different techniques to stay positive. Mindfulness: Living in the present moment, which is the meditative practice of an optimistic age. The Four A’s Of Positive Aging  Accept: Accept your mark of aging, whether mobility loss, age spots, wrinkles, or accept it. Adapt: After accepting comes adapting, which means using a walker when you've lost your mobility. Appreciate: Appreciate everything you have in life while confronting a mark of aging like mobility and loss.  Attitude: You have to have the right mindset about aging. We've climbed the hill in our lives. But you know what? We're not going down the hill. We'll stay on top and look at the scenery—that's what attitude is all about with aging. Social Support-We're social animals, we're human beings, and we need support from friends and family. Such support is essential when you're aging because you may be losing your spouse at some point. You may be losing some close friends. Thus, it would be best if you expand your social network continually.  Balance-When you age, you get out of balance. You're no longer bringing up a family with children. You're no longer striving in your career to get better and better at what you're doing now. You're retired, you're an empty nester, and you've got time on your hands—you're out of balance. And when you're out of balance, you experience stress, and you experience anxiety. We need to stay balanced in our twilight years, and that helps immensely. Part Two Of 'How to Age Well: The Power Positive Aging' United We Age—Social Support For older adults In Need The United We Age non-profit organization came from Dr. David Lereah's experience with Meals on Wheels, where he delivers hot meals to older adults in need. While volunteering for Meals from Wheels, he noticed that half the older adults on his route lost their zest for life. They were just like if you're in a laundry room waiting for the clothes to dry.  One reason was that they did not have social interaction as they were vacant of any social interaction. They didn't have a family; no family was visiting them. It turns out that half the people in long-term care facilities don't have family visiting them for one reason or another. It might be because their children live a thousand miles away, or they don't have a relationship with their family at all—they're lonely. "The best thing is to eliminate your expectations when you're in your twilight years, have possibilities instead—that way, you won't be disappointed." David Lereah, PhD From there, Dr. David Lereah created United We Age, where they…. Assure that every person experiencing a quality of life that declines due to aging has a social support network, especially living alone.  Raise Awareness and Image Building for Older Adults Assure that age is not a barrier to older adults participating in the online (internet) world.​ Inspire a movement where all generations of people are more aware and supportive of people aging.​     Assure that age is not a barrier to older adults participating in the online (internet) world​ Inspire a movement that affects changes in cultural beliefs and attitudes to make America a more age-friendly nation.   About David Lereah, PhD: Dr. David Lereah was diagnosed with Stage 3 esophageal cancer, went on a journey, and wrote the Power of Positive Aging. He created a non-profit, United We Age, designed to support older adults in need. Other Valuable Resources From Dr. David Lereah: Amazon Alexa and Echo Dot use Speak2, a voice technology platform, provides older adults in need to reduce social isolation and is available for free. Voice-assisted way to connect to the internet, send and receive messages using voice commands. Echo Show 2 Partnering with Meals on Wheels. To purchase a copy of The Power of Positive Aging – click here  How to prepare to grow old quiz: https://www.unitedweage.org/survey Connect With Dr. David Lereah, PhD: United We Age Website:   https://www.unitedweage.org Twitter: @UnitedWeAge @NextAvenue @GensUnited @amazon Email:  dlereah@unitedweage.org Phone: 703-843-1124 About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults.  I worked full-time for five years as an FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor.  My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Oct 12

26 min 35 sec

If you wish to maintain health and longevity as you age, it may be helpful to include a special muscle group in your workout: your creative muscles.  According to ongoing studies, creativity is essential for healthy aging. Engaging in creative activities like singing, theater, and visual art may help older people feel better. Further, creativity, linked to the personality characteristic of openness, can help people live longer. In this  episode of This Is Getting Old: Moving Towards An Age-Friendly World, we're privileged to have Teresa  Bonner, the Executive Director of Aroha Philanthropies. Join us as we share meaningful conversations about creative aging and how it sparks joy, connection, and purpose among older adults.  Part One Of 'Creative Aging Sparks Joy, Connection, Purpose' Aroha Philanthropies And Creative Aging “Creativity is hardly the exclusive province of youth. It can blossom at any age—and in fact, it can bloom with more depth and richness in older adults because their vast stores inform it of knowledge and experience.”          —Dr. Gene Cohen, Geriatric Psychiatrist These words of Dr. Gene Cohen, the founding Director of The George Washington University’s Center for Aging, Health and Humanities (for which I am the current Director), is Aroha Philanthropies' motivation in advocating creativity in aging. According to Dr. Cohen's landmark report, 85% of older adults are community-based, are aging well,  can learn, be creative, and be so much more. With this visions in mind, Aroha Philanthropies are on a mission to expand creative aging programs nationally. They're engaged in funded training for organizations to learn how to make successful programs for older adults—to learn an art form over time and to get better and better as they learn from a teaching artist.  Furthermore, Aroha Philanthropies has built national partnerships with the American Alliance of Museums, including botanical gardens, science museums, etc., to offer creative programs for older adults. This partnership has called on museums of all kinds around the country to develop creative aging programs and actively work against ageism in their institutions. What's even more promising is that they've tapped on The National Assembly of State Arts Agencies, where they've funded 36 state programs to develop and/or expand creative aging. Aroha Philanthropies' efforts in evangelizing about the benefits of getting involved in the arts were not in vain. What they've learned from almost 2 000 participant survey responses is that after engaging in creative aging programs, older adults; Developed relationships Learned various art forms Became cognitively and socially engaged Made meaningful social connections through art-making "Creative aging programs were highly effective at helping older adults grow artistically, mentally, and socially. 75% of 2,000 older adults reported that their mental engagement had increased because of taking creative classes." Teresa  Bonner,  Executive Director of Aroha Philanthropies How Do You Define Creative Aging? Creative aging is about learning an art form over time in a supportive environment. Such a supportive environment allows older adults to grow and become creative, more artistic and increase their social connections and social network. It is a broad topic that includes everything from programs designed to provide help for people suffering from diseases such as dementia to programs for caregivers who help with art therapy programs.  The learning and connection, and relationship building happen through the work of the teaching artist. In part, these teaching artists know how to have conversations with people and generate conversations among them through the art form.  That's the heart of successful creative aging programs. Older adults are learning over time from a teaching artist; they get better and make new friends.  Examples of the classes offered in creative aging programs are: Acting  Writing Drawing Dancing Sculpture Mask making Opera singing Learning graffiti Short Video Filming  Drumming and beating Technical and historical aspects Choir and theatre arts performing Weaving where they also know about the  history and the people What Do You Consider To Be A Supportive Environment? Supportive environments for creative aging provides opportunities for those who are 55 and better to access and benefit from arts programming designed to teach older Americans an art form over time. Aroha Philanthropies want to expand these opportunities through increased investment in creative aging programs. Part Two Of 'Creative Aging Sparks Joy, Connection, Purpose' Elements That A Thriving Creative Aging Program Have As a safe space for being creative, a successful creative aging program is:    Designed To Meet The Express Needs And Interests Of Older Adults   Rather than assuming that older adults don't have much capacity, they're allowed to come together and have rich stories to share. They learn new skills, get involved in new activities, and enhance their own lived experience    They Are Led By Teaching Artists   Teaching artists are professional, working artists who are also skilled in arts education. They create space for participants to offer feedback to one another, discuss their work, talk about memories, and talk about dreams.  It's a two-way process, which is an essential aspect of community building among participants. Teaching artists are part of the secret sauce; they create that chocolate for the brain!    Experiential And Sequential   A successful creative aging program is experiential—they're more hands-on. At the same time, it is sequential, meaning older adults learn to create over time. They're not just learning about the great masters of the art; they're making the art themselves.  Moreover, each class builds on the skills they learned in the prior classes. Essentially, these are often so interesting to older adults.     Builds Social Interaction And Engagement    In every creative aging, session participants are encouraged to share their experiences and memories. They discuss their work and offer feedback, which is an excellent way for people to begin building their social network.   Celebrate Achievements    The common theme of successful creative aging programs is the celebration of the participants' creations. The culminating activity is open to friends, family, and sometimes the public. This allows friends, family, and others in the community to see older adults in a new light. These are the kinds of things that move us from seeing an older adult as old and seeing them as a person and creative individual.  “The financial burden of social isolation for older adults is at 6.7 billion dollars because social isolation produces significant negative health impacts. Creative aging programs are a societal benefit in addition to an individual and community benefit. There are all kinds of great reasons that creative aging should be going forward all over the country.” -Teresa Bonner,  Executive Director of Aroha Philanthropies What Are The Benefits Of Being Part Of A Creative Community? Creative aging helps older Americans combat social isolation, an increasing problem for America's growing older population, especially throughout the pandemic. Furthermore, doing the celebrations, sharing what is created, and building connections are solid and powerful pieces of combating ageism. We see an older adult as a person—not like an older person—a person who's had a whole life of experiences. The Power Of Connecting Through Art When you're working through the art form, you are vulnerable. Creative aging is not like having a cup of coffee after choir practice. It's where you're talking about your own life, dreams, and interests, which naturally leads to relationships among people that can be important.  Arts are a connecting point in a time where the connection is essential. Older artists find joy, purpose, community, and creativity in these programs. How Do You Find A Creative Art + Aging Group In Your Area?  There are many resources for learning about Creative Aging. If you're interested, you can check on the following; Aroha Philanthropies Website:  aroha philanthropies.org Facebook: www.facebook.com/arohaphilanthropies Twitter: www.twitter.com/ArohaPhil Instagram: @arohaphilanthropies Lifetime Arts-which provides consulting and training on how to run creative aging programs. Creative Aging Resource- a rich website devoted to creative aging,  also developed by Lifetime Arts National Assembly of State Art Agencies-They offered grant programs this year and awarded funds to 36 states that are either developing creative aging programs or want to create them and wish to learn about them.  The American Alliance of Museums-They had put out a significant report calling on museums to ethically and strategically prioritize developing creative aging programs that work with older adults differently. Countering Isolation with Creativity About Teresa Bonner, Executive Director, Aroha Philanthropies: Teresa Bonner brings more than thirty years of professional experience in philanthropy, foundation, and nonprofit leadership to her role as Executive Director for Aroha Philanthropies. She is a frequent presenter on philanthropy and creative aging, including sessions at the National Assembly of State Arts Agencies, Grantmakers in the Arts, Grantmakers in Aging, Americans for the Arts, Philanthropy New York, and the American Society on Aging. Teresa previously served as Director of the U.S. Bancorp Foundation. She managed $20 million in Foundation grantmaking annually. She led the company's community relations activities, the Piper Jaffray Foundation, and two nonprofit organizations, Milkweed Editions and the Library Foundation of Hennepin County. Arts and cultural programs have long been a significant focus of her professional experience and a personal passion. She is a principal in Family Philanthropy Advisors, with offices in Minneapolis and the Bay Area. Teresa graduated magna cum laude from the University of North Dakota with a degree in journalism. After completing Law School at the University of Minnesota, she clerked for the Hon. Gerald Heaney of the U.S. Court of Appeals for the Eighth Circuit and was a partner at the Minneapolis law firm of Lindquist and Vennum before moving to the nonprofit sector. About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as an FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Oct 5

24 min 57 sec

Alzheimer's Disease Care: 3 Tips for Eating and Drinking at Home I went home to help my 70-year old mother take care of my 91-year old grandmother, who'd been in a nursing home for a year and a half during COVID. Grandma Trudie was extremely debilitated, and in this episode, I share. When your loved one is as weak as my grandmother was, you may need to make some adjustments that allow her to continue to feed herself. This video is part of a 3-part series on Alzheimer's Care and the other videos can be found where you found this one. ✔️ Tip 1: Drinking with Closed Handle Cup My mom purchased an insulated cup that probably didn't weigh more than like a pound and a half - at the most - but it was too heavy for my grandmother to pick up by herself. Tip number one is to think about getting a cup with a closed handle. If the cup has two handles, one on each side, it will be easier for the person to hold the cup with two hands. ✔️ Tip 2: Mechanical Soft Diet  For patients who usually don't have teeth, creating a mechanical soft diet is very important. Foods mechanically are foods altered by blending, grinding, chopping, or mashing the foods so that they are easier to chew and swallow. ✔️ Tip 3: Using an Apron My grandmother, even though she can feed herself, sometimes spills her food when eating.  Instead of putting a traditional bib on her, my Mom had the idea to use an apron. This is a really unique thing caregivers can do pretty easily to maintain someone's dignity and to be respectful of them. The apron  allows them to eat on their own, and still look cute and fashionable.  You can check out the Part 1 & 2 episode where you found this one – in Part 1, I talked about 3 Tips for Transferring & Getting Dressed; and in Part II, I talked about 3 Tips to Shampoo Hair in Sitting in a Chair. If you have questions, comments, or need help, please feel free to drop a one-minute audio or video clip and email it to me at melissabphd@gmail.com, and I will get back to you as soon as possible.  About Melissa Batchelor, Ph.D., RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.  

Sep 28

4 min 31 sec

I went home to help my 70-year old mother take care of my 91-year old grandmother, who'd been in a nursing home for a year and a half during COVID. Grandma Trudie was extremely debilitated and my Mom needed me to help her figure out how to provide basic care - including how to wash her hair.  In this episode, which is part of a 3-part series on Alzheimer's Care, I will give you 3 Tips for how to shampoo someone’s hair while sitting in a chair.  My Grandma Trudie has pretty significant seborrheic dermatitis on her scalp, which is a common skin condition that causes scaly red patches, red skin, and stubborn dandruff. Treatment for it involves using a certain type of shampoo to remove the buildup of dead skin with gentle removal of the dead skin a few times a week until it clears up.   On top of not being able to recline or having the setup of a beautician's shop, she is also always cold - so we needed to wrap her up and make sure we didn't get her wet (or make a mess!)  3 Tips to Shampoo Hair in Sitting in a Chair ✔️ Tip 1: Be organized and make sure that you have all of the equipment you will need. Prepare a couple of towels and washcloths, and then have the special shampoo that you need to wash somebody's hair with. We had a brush and then a comb that had two different layers to it, which would allow us to gently brush the dry skin off of her scalp and then comb it out of her hair. ✔️  Tip 2: How to Shampoo Hair in a Chair.  We didn’t need to run the water on her, because her hair is so thin that we could wet it with a washcloth. We added her medicated shampoo and used the brush to gently massage her scalp. Then we had her lean forward a little and I used my hand to guide the water into the bowl my Mom held below her while pouring water from the pitcher. Then we dried the hair and used the comb to get the dead skin off the scalp and hair. ✔️ Tip 3: Incorporating Play and Staying #Fancy.  Apparently my family and I like to play “peep eyes"quite a bit. While we were working on Grandma’s hair, my Mom played “peep eyes” with my Grandma as she was finishing drying off her face after we rinsed her hair. The final product was a  beautiful Grandma and Mama! Remember that even though caregiving is stressful and presents some unique challenges to deal with, it is always important to remember to build in some fun and to be playful because those are the memories you’ll have forever that are good.  (You can check out the Part 1 & 3 episodes where you found this one.) Part 1: 3 Tips to Transferring & Getting Dressed https://youtu.be/XztGYUbAy7Q Part 3: 3 Tips for Eating and Drinking at Home.   If you have questions, comments, or need help, please feel free to drop a one-minute audio or video clip and email it to me at melissabphd@gmail.com, and I will get back to you ASAP with an answer to your question.    About Melissa Batchelor, Ph.D., RN, FNP-BC, FGSA, FAAN:   I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Sep 21

5 min 31 sec

I went home to help my 70-year old mother take care of my 91-year old grandmother, who'd been in a nursing home for a year and a half during COVID. Grandma Trudie was extremely debilitated, and could only bear her body weight when she first came home. She could not pick up her feet to even step side-to-side or pivot - which had the potential to put a lot of work on my Mom’s back until Grandma Trudie regained some of the strength in her legs..  In this episode, I share a 3-part series on Alzheimer's Care. When your loved one is as debilitated as my grandmother, you can't move her from place to place easily.  3 Tips for Transferring & Getting Dressed ✔️ Tip 1: Consolidate Movement to Minimize Risk of Injury   Thinking through moves from bed to chair; with bedside commode stop in between. Lining up and minimizing the number of transitions   Do as many steps in getting dressed or undressed while sitting, then moved her,  Getting her into bed to lie down with one movement  ✔️ Tip 2: Using a Hospital Bed: It Goes UP for a reason Lowest position when getting in or out of bed Save Your Back – Roll the bed up as high as you need it to be to provide care Use Side rails when bed is being used. ✔️ Tip 3: The Power of the Rolling Side to Side To get her brief on She could help by grabbing the siderails – doubles as good exercise! (You can check out the Part 2 & 3 episode where you found this one.) Part 2: 3 Tips to Shampoo Hair in Sitting in a Chair Part 3: 3 Tips for Eating and Drinking at Home. If you have questions, comments, or need help, please feel free to drop a one-minute audio or video clip and email it to me at melissabphd@gmail.com, and I will get back to you by recording an answer to your question.    About Melissa Batchelor, Ph.D., RN, FNP-BC, FGSA, FAAN:   I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Sep 16

4 min 35 sec

Have you ever felt like someone discriminated against you because of your age? Maybe you didn't get that promotion because you were too young, or perhaps you felt like they didn't hire you because you were too old.  In either scenario, I doubt you ran down the road and told your friends because you had just been the victim of a “raging ageist”.  In this episode of This is Getting Old podcast, we tackle the biggest problem with America's mindset about aging and the prejudices that today's current older adults face and generations to follow will too, unless we make some major cultural changes. Key points covered in this episode:  ✔️ In the next ten years, we all know we're going to have more older adults on the planet than children for the first time in human history. And we largely attribute that to the Boomers.  ✔️ Did you also know that two years ago, millennials took over as the largest generation? This year (2021), Millennials are beginning to turn 40, makingthem old enough to sue for age discrimination in the workplace. So this includes people like  Justin Timberlake, Eli Manning, Alicia Keys - anyone born before 1997. ✔️ Ageism is the only form of discrimination largely absent from our national dialogue around diversity and inclusion. While the other "-isms" split us up, it is a fact that aging is something that we're all doing.    ✔️ Ageism is also the only concept that we socially accept - and even project - onto ourselves. We have about 25 years to find the policies and solutions to make the world more age-friendly and eradicate ageism.  If you have questions, comments, or need help, please feel free to drop one-minute audio or video clip and email it to me at melissabphd@gmail.com, and I will get back to you by recording an answer to your question.  About Melissa Batchelor, Ph.D., RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Sep 2

3 min 41 sec

New Drug for Alzheimer's Disease "Don't let yourself be sucked in by all of the publicity and marketing about the new drug for Alzheimer's. Think about whether it's got any benefit, the side effects— which can be very severe, and think about where that money otherwise would go." Howard Gleckman, Senior Fellow, Consultant, and Editor, TaxVox Blog ________________________________________________ Aducanumab (brand name AduhelmTM) received expedited approval from the Food and Drug Administration (FDA) on June 7, 2021, making it the first Alzheimer's disease drug approved after 18 years.    Since then, the FDA has changed the approval's original wording to suggest that it be used exclusively in select individuals with moderate cognitive decline or early Alzheimer's disease.   Further research is now being done because of the FDA's recent approval of Aduhelm, which sparked worries about its safety, efficacy, and cost.    In today's episode of This Is Getting Old: Moving Towards An Age-Friendly World, we will be talking about The New Drug for Alzheimer's Disease known as Aducanumab (marketed as AduhelmTM). Today, I am joined by Howard Gleckman, a Senior Fellow with the Urban Institute, who will shed some light on the newest drug available for Alzheimer's disease. Part One Of 'New Drug for Alzheimer's Disease’ Understanding Alzheimer's Disease In A Nutshell Alzheimer's disease is only one form of dementia; there are many other types, including Vascular disease, Lewy Body disease, Frontotemporal Degeneration (FTD), Parkinson's, and mixed pathologies. Alzheimer's disease is the most common form – 60-80% of all cases of dementia, but many people do have mixed pathologies, meaning they have more than one form of the disease. This is complicated because confirming what type or types of dementia a person has can only be done by autopsy (I've done a previous podcast on how Alzheimer's disease is diagnosed if you would like to learn more).    You can also learn more about Alzheimer's Facts and Figures (2021), an annual report published by the Alzheimer's Association, to learn more about the different types of dementia and associated characteristics (pages 6 and 7 of the 2021 report).  Signs And Symptoms Of Alzheimer's Disease Early symptoms of Alzheimer's disease are trouble with your memory – remembering recent conversations, names, or events – or being depressed or apathetic, which means having a general lack of interest or enthusiasm about things you were formerly excited about.   As the disease progresses and moves into the moderate and advanced stages, symptoms include difficulty communicating with words, being disoriented, confused, having poor judgment, behavioral changes, and ultimately, in the end stages, difficulty speaking, walking, and swallowing.  "Not all people with MCI transition into Alzheimer's disease. We don't know or understand the mechanism of why that happens, why some people transition, or some people don't. So then you could be potentially giving a drug to a group of people that would have never progressed to Alzheimer's disease."  Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN The Brain Changes From A Grape To A Raisin With Alzheimer's In Alzheimer's disease, the brain shrinks – can be seen on a head CT; and two proteins called beta-amyloid and tau develop and somehow become toxic to the brain. The beta-amyloid clumps into plaques, which slowly build up between neurons, and abnormal tau accumulate, eventually forming tangles inside the neurons. As the level of amyloid reaches a tipping point, there is a rapid spread of tau throughout the brain. These plaques and tangles cause the neurons to lose their ability to communicate. The NIH has a great 4-minute video that shows you this process visually. Drugs For Alzheimer's: What's On The Horizon? Acetylcholine is a neurotransmitter that also plays an essential role in cognitive function related to memory and paying attention.  Acetylcholinesterase is an enzyme that breaks down acetylcholine – so cholinesterase inhibitors are oral medications that prevent the breakdown of acetylcholine.   Right now, we have at least 3 Acetylcholinesterase inhibitors drugs approved by the FDA that work for a certain period but don't modify the disease course.   Scientists are working on new treatments for Alzheimer's that include  anti-amyloid therapy, anti neuroinflammation therapy, Anti-Tau therapy, Neuroprotection, cognitive enhancers, and medications that relieve the behavioral and psychological symptoms often seen in dementia.   Part Two Of 'New Drug for Alzheimer's Disease’ Aducanumab (Brand Name AduhelmTM) The Newly Approved Alzheimer's Drug. Should You Take It? How Aducanumab (AduhelmTM) Works (Or Suppose To Work)? Aducanumab (Aduhelm) is a monoclonal antibody developed in a facility to bind to the amyloid molecule that causes plaques in Alzheimer's patient's brains. According to most experts, the plaques develop first and harm brain cells, prompting tau tangles to grow within them, eventually killing the cells.  When Aducanumab binds to the plaque, the body's immune system attacks it, mistaking it for a foreign intruder and removing it. The goal is that after the plaques are eliminated, the brain cells would stop dying, and thought, cognition, function, memory, and behavior will improve. How Aducanumab (AduhelmTM) Is Administered? The newly approved Aducanumab (AduhelmTM) is a Medicare part B drug. Most of us are familiar with the Part D drugs, which are the pills that we buy in the pharmacy. Part B drugs, on the other hand, are injectables or infusion drugs. That means you generally get this drug at a physician's clinic, an infusion center, or a hospital. Simply put, to take the drug, you need an intravenous infusion every four weeks — forever. Who Qualifies For Aducanumab (AduhelmTM)? Physicians may prescribe the medication for treatment in people with early-stage Alzheimer's disease based on the clinical studies that were conducted.  Early-stage Alzheimer's disease patients refer to people with Alzheimer's disease in the early stages of the disease, such as moderate cognitive impairment or mild dementia. People living with early stage Alzheimer's disease may be able to operate normally, or they may need assistance with more complex tasks such as bill payments, grocery shopping, cooking, or managing their checkbook. Those who need help with bathing, grooming, or other basic tasks are not in the early stages of the disease, and the medication is not recommended for them.   However, it's best to note that Alzheimer's disease does not affect anyone with moderate cognitive impairment or mild dementia. There are a variety of additional factors that contribute to these issues. Alzheimer's can only be diagnosed by an amyloid PET scan or lumbar puncture, both of which confirm the presence of Alzheimer's amyloid plaques. Most insurance plans now cover a lumbar puncture; however, an amyloid PET scan (which costs about $5,000) is not. Furthermore, what makes Alzheimer's disease different from other chronic conditions is the blood-brain barrier. How do you get the drug through that blood-brain barrier that's meant to protect the brain? "FDA's decision is giving people false hope. It's making them believe that if they scrape together somehow all of this money, there's going to be this magic cure for this disease, and we don't have the evidence that that's true."    Howard Gleckman, Senior Fellow, Consultant, and Editor, TaxVox How Much Does Aducanumab (Aduhelm) Cost? Howard Gleckman explained that Aducanumab is estimated to cost $56,000 per year by Biogen, the company that manufactures it. It is unknown if this medicine will be covered by Medicaid, Medicare, or private insurance. Biogen said they're working on a deal with the Veterans Health Administration (VA) to pay for this drug for veterans receiving VA treatment. However, VA said they would not include it in their formulary, and private insurance companies are all over the place.    Similarly, the Center for Medicare and Medicaid Services (CMS) is still not sure if they will cover the drug. And if they do, AduhelmTM would be covered by Medicare Part B (because it's an infusion) rather than Medicare Part D (prescription drug coverage). And even if they do decide to cover the medication, Medicare only pays 80% of Part B costs and 20% is out-of-pocket for consumers. Annual out-of-pocket costs would be over $11,000 -these costs  make the drug out of reach for many Americans. Howard asks that when considering the cost being $56 000 a year per person, what will it cost Medicare annually? When the drug has not been found to be effective,  we could be investing in the Home and Community-Based Services (HCBS) that we have evidence do work. The bottom line is that geriatricians and healthcare providers are left to explain to patients why they are not eligible to take this medication, and why  it's considered a "scam" by scientists and healthcare professionals alike. But, Does Aducanumab (AduhelmTM) Work? Briefly stated, there were two major clinical studies to determine the drug's efficacy, side effects, and overall safety. One of the trials returned positive, indicating that the medication helped to halt the loss in cognition, memory, and functioning that is so common in Alzheimer's disease.    The results of the other extensive research were negative. The findings indicate that there's no evidence to prove whether the drug is working or not.   Another element to decide is that the perceived upside — if the medication performs as much as it did in the successful trial — is next to nothing.    The Role Played By The Food and Drug Administration (FDA) The FDA was established in 1906 to protect consumers from unsafe medications and unsafe substances that falsely claimed efficacy for some treatment without proof.  Long-standing FDA Approval Process for all drugs built on how clinical trials are conducted to move medication from the laboratory into use by human beings. With that, FDA approval can take 12-15 years at an average cost of $2.6 billion to a manufacturer. Biogen spent about 18 billion dollars to develop this drug.    Moreover, in 14 clinical trials, after significantly reducing beta-amyloid, this drug did not result in a significant change in Mini-Mental State Examination scores. In other words, there has been no convincing clinical evidence that clearing beta-amyloid from the brain results in any benefit to the patient. The FDA ignored the recommendation of an Independent Data Monitoring Committee that found zero evidence that this drug slowed down AD progression; in fact, patients given Aducanumab in the trials did worse than patients who received the placebo.  The Independent Data Monitoring Committee recommended that the Phase III trial of Aducanumab be terminated.   These actions made by the FDA in ignoring the recommendations of the Expert Alzheimer's Disease Panel and approving the drug for use caused three members to quit and raised several controversies.  About Howard Gleckman, Senior Fellow, Consultant and Editor, TaxVox Blog Howard Gleckman is a senior fellow in the Urban-Brookings Tax Policy Center at the Urban Institute. He is also affiliated with Urban's Program on Retirement Policy and is the author of the book Caring for Our Parents. He also writes two regular columns for Forbes.com, on tax policy and eldercare.   Connect with Howard by checking out his Personal Blog   About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN:   I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as an FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.  

Sep 1

35 min 36 sec

In this episode of This is Getting Old podcast, listen if you are coping with handling an older person or loved one going through repetitive verbalizations and Alzheimer's Disease.  Let me tell you a story of two residents that I used to take care of a long time ago — Walter and Miss Lucy and how we managed their behaviors. Every day, about three o'clock in the afternoon, Walter would begin to yell, "I'm a bad man!" And he would do that all the time. And the irony is, Walter used to be a pastor when he was younger. But as soon as that happened, instead of giving him some medication to manage his behavior, we knew we just needed to take him out to have a cigarette.  When Miss Lucy would start calling the hogs in her wheelchair shouting "Zoe! Zoe!" in the afternoons, we knew that it's time that she needed some snuff or smokeless tobacco. We would give her some snuff, and she would take off down the hall.  Key Takeaways: ✔️ If a patient with advanced Alzheimer's is a lifelong smoker, we can no longer change that behavior as carers. While smoking isn't ideal, one way to manage that behavior in a non-pharmacological way is to give them what they needed at that time, which was nicotine.  ✔️ The same thing could happen with someone that you're caring for. Think about their habits before, and it could be they need caffeine, going for a walk to get some exercise in. If you have questions, comments, or need help, please feel free to drop a one-minute audio or video clip and email it to me at melissabphd@gmail.com, and I will get back to you by recording an answer to your question.  About Melissa Batchelor, Ph.D., RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.  

Aug 26

4 min 14 sec

Self-imposed ageism is real. I’d be interested in your thoughts about this quote - drop a comment below. In the words of Maggie Kuhn founder Gray Panthers, "The first myth is that old age is a disease, a terrible disease that you never admit you've got, so you lie about your age. Well, it's not a disease—it's a triumph because you've survived. Failure, disappointment, sickness, loss—you're still here." While I know Maggie Kuhn did great work founding the Gray Panthers and was actually a early advocate for not forcing people to retire at age 65 - and had an age-inclusive focus and advocated for college students to be taken more seriously - the thought of equating aging to mere survival of failure, disappointment, sickness and loss to only reflect one side of the coin of aging. Where is the celebration of major life milestones, her achievements, her “wins” in the third-third of her life?  It’s one quote, from one moment in time, so I digress...but I hope this makes you think about how you think, and and how WE talk, about aging in 2021. Today’s episode picks up with how should we be telling the story of aging? We'll talk more about Reframing Aging to continue the 2-part series of Aging: Words Matter at This Is Getting Old: Moving Toward An Age-Friendly World.  Tune in as Patricia D'Antonio, BSPharm, MS, MBA, BCGP, further elucidates why words matter, particularly regarding how they may generate and promote discrimination, fear, and misconception around aging.   Part One Of 'Aging: Words Matter Part 2.' The Leaders of Aging Organizations collaborated with the FrameWorks Institute, which studied and reflected on the gap between popular views and misconceptions about aging.  They discussed ways to move to more positive narratives that "progress a perspective of older age as a time of challenges and possibilities, counteracting the fatalistic notion that aging outcomes couldn't be even better." How Should We Be Telling The Story Of Aging? We all take cognitive shortcuts to interpret and understand all sorts of experiences, thoughts, and feelings about aging. We take these for granted, and they are primarily automatic assumptions. However, remember that a compelling narrative builds understanding, shifts attitudes, and generates support for policy solutions.   Framing Is About Choices      Frames are choices about how information is presented, what to emphasize, how to explain it, and what to leave unsaid.  When a Frame "works," it shifts thinking in multiple ways— knowledge increases, attitudes improve, and policy support grows. Our goal with this project is to be able to get policies that support us as we age. - Patricia D’Antonio, BSPharm, MS, MBA, BCGP What Should We Do? In our communications, we can make choices that activate productive cues/shortcuts to advance helpful models about aging. It's Important to tell the positive story of aging, but not just any story. We can get people to talk about aging and change the discourse on what people think about it. As we start to do that, ultimately, our goal t is to be able to get policies that support us as we age so we can get that discussion going and get people to start to think about aging differently. Consider the following for a compelling narrative: Why does this narrative matter? Include tested values that we know move the needle on thinking about aging How does this narrative work? Provide explanation   What can we do about it? Offer concrete systemic solutions.  Incorporate the values of Justice and Ingenuity Justice – Highlight that our society should treat older people as equals and ensure meaningful opportunities to contribute Ingenuity – Provide encouragements and positive reinforcements like saying, "We are resourceful and can find new and creative solutions for the challenges that come as we age." Avoid   Equating aging with decline  Cuing individualism  Portraying older people as other   Describing the aging of the population as a crisis  Talking about resources as fixed or finite   Advance ✔️ That context and environment shape decisions and outcomes   ✔️ The value of ingenuity ✔️ Inclusion and the use of "we." ✔️ An explanation that underlying social conditions influence   health, financial security, employment  ✔️ Systemic solutions   Part Two of 'Aging: Words Matter Part 2.' Research Findings: Word Choice Matters! Words like "seniors" and “the elderly" drive thinking that we are less competent as we age. This terms are “othering” rather than being inclusive.  Using words like “older adult” or “older people” - but realize that in using these terms, an 18 year old may think about people in their 50’s. References to “older adults” generally call to mind someone in their mid-fifties, which doesn't quite get us as advocates to the age range we want to address “Older people” evokes people aged 60 or older and at the same time brings with it the most positive, least paternalistic view of the age described in the public mind.   So experts need to communicate with the public to make sure that the thinking for Americans is positive about aging because it can shorten your lifespan, and you end up with more health problems because of it.  Impact Of Reframing Aging With AP/ AMA/ APA Style Guides   Adopting the concepts of Reframing Aging will improve how we hear, read about aging in a way that again cues the more productive thinking about aging. The American Medical Association (AMA), the American Psychological Association (APA), and even the Associated Press (AP) have updated their style manuals to adopt language around aging. So instead of using the word "seniors" and "elderly," they refer to older people or be specific about the age group. “The first step in fixing ageism is to raise awareness.” - Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN Role Of Implicit Bias Around Aging   Defining Ageism and Implicit Bias?   Ageism is the discrimination of any person of any age—the tendency to regard older people as debilitating. We have some subconscious thoughts about that. It starts when we're very young about taking in information about aging and older people.  Consequently, it becomes thoughts and feelings that you have that you don't even realize. Such thoughts and feelings are implicit biases. We have an implicit bias about many things, but it's the internalized bias tied to how we want to process so much information.    Implicit Biases Can Be Harmful   Implicit biases can be harmful and challenging for all of us to think about that. Some of the things that we work on are we help people develop "well-framed messages." We ask people what they think about aging. They give us their answers which are more around those negative models that we talk about—us versus them, the fatalism, the individualism. We read them well-framed sentences about aging, and a couple of minutes later, we see the difference in how the same people respond. Conclusively, our research shows that communicating a positive understanding of the aging process mitigates sources of implicit bias. Join the cause of Moving Towards an Age-Friendly World by checking on the following helpful resources: Call out ageism when you see it or hear it - Words Matter Practice using the tips on the Quick Start Guide Learn (Getting Started)about the Swamp of Public Opinion on Aging and other research on the Reframing Aging Initiative webpage (www.reframingaging.org)   Request a workshop or presentation for your organization Associated Press (AP), American Medical Association (AMA) and the American Psychological Association (APA) Style Guide recommendations    How to access training Subscribe to the Caravan newsletter About Patricia D’Antonio, BSPharm, MS, MBA, BCGP: Patricia M. "Trish" D'Antonio, BSPharm, MS, MBA, BCGP, is GSA's vice president of professional policy affairs. In this role, she is responsible for managing the Society's relationships with other organizations in the aging arena, leading major Society programs and projects, and developing a strategy for future growth of the National Academy on an Aging Society (GSA's nonpartisan public policy institute). She is also the project director for the Reframing Aging Initiative, a long-term social change endeavor designed to improve the public's understanding of what aging means and the many ways that older people contribute to our society. About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as an FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Aug 24

28 min 29 sec

Words are powerful. They influence how we think, behave and approach things. They can produce labels, misunderstandings, misrepresentations and change our perceptions in profound and meaningful ways. In this episode of This Is Getting Old: Moving Towards an Age-Friendly World showcases GSA's work on Reframing Aging. Tune in as our guest —Patricia D'Antonio, BSPharm, MS, MBA, BCGP—offers us ways to reframe our language when talking about and thinking about aging. Part One of 'Aging: Words Matter Part 1.' What Is The Reframing Aging Initiative?  Reframing Aging is a social change endeavor designed to improve the public's understanding of aging. The GSA's ongoing effort is fostering a new language in talking about getting older that leads to more substantial support for age-friendly services and policies. This initiative, in turn, plays a critical role in ensuring that the public recognizes that there is much we can do collectively to ensure well-being as we age by following the concepts of Reframing Aging.  Reframing Aging is an evidence-based communications strategy led by 10 National Aging Organizations – American Federation on Aging, the American Society on Aging, the American Geriatrics Society, and Grantmakers in Aging.  Ageism is often not recognized. Ageism intersects with all of the -isms and impacts all of us; no matter how old we are. What we've learned in our research is there are challenges in how the public thinks around aging. Some of that comes around the following:   Cultural Models That Drive People's Thinking   Cultural models are patterns of thinking or assumptions created through years of experience.  People rely on cultural models to interpret, organize and make meaning out of all sorts of stimuli, including experiences, feelings, thoughts, and communications.   Impact of Ideal vs. Perceived Real Views Of Aging   Ideal views of aging is that older adults accumulated Wisdom, are self-sufficient, are staying active, and earned the leisure perceived  Whereas the "Real" views of aging are deterioration, loss of control, and dependency We can see challenges here when many people see aging as getting older means more health issues, which means more doctor's visits and medications than, one of the advantages of getting older is you get to relax more. “Self-ageism is either delaying care or not allowing you to get the care you need because of self-imposed ageism. - Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN   Impact of individualism    An excellent example of individualism is when somebody says something like, "If you exercise and eat right, you'll age well." Except we need to think about the systems around us that make sure that we have that opportunity to eat well and exercise. Then just saying if you only eat well doesn't get you to that systemic solution that we need to create.  Another place where that's important to think about is when people talk about financial planning. So when you're retiring, if you only just put money away every month, you would have money for when you retire.  Well, if I am in a system where I'm working three jobs to make ends meet, I may not be in the position right now to be able to save for retirement. It doesn't absolve people from having to take some action. So we need to ensure that there are policies in place that support all of us as we age.   Impact of “Us” vs. “Them” Dichotomy Thinking about Aging     When we start to tell stories that create that "us" versus "them," it does put people and make people think that we are two different models in our brains. When we start to think about this, it impedes how we think about support for aging in any way. There's this dichotomy of everybody on a cruise, that life of leisure or somebody jumping out of the air, out of an airplane, or everybody is very sick and decrepit.  They need help, they're frail, they need help with whatever is going to happen. Those kinds of pictures don't help us gain support and understand what aging means and how we all contribute to society even as we age. Impact of Fatalism  Fatalism is the culture that makes people think, "If this is a tsunami, I'm going to run someplace. I'm getting out of here."  We learn in those fatalistic crises kind of messages, which when you work in policy, you have to make it a crisis so that anybody will take action.  But honestly, what we learned through the research is people say, “There's no solution here, so I'm going to go someplace else”. So when we talk about this tsunami, as much as it does make people look at it differently, let's go someplace else where we can make a difference.  But there are things we can do to collectively age well. There are solutions. We can solve problems; we have a collective responsibility to create policies that benefit all generations; and recognizing what is around us shapes us - social determinants of health matter - from age-friendly cities with adequate transportation, housing, and other age-friendly domains. Part Two of 'Aging: Words Matter Part 1.' Why Reframe Aging?   Ageism Harms Us All   Ageism is discrimination against a person based on age, and it shapes the way we think about ourselves and others as we age.  Many people don't realize how ageism impacts our health. One area where we have seen is that one in every seven dollars spent in health care, which roughly equates to sixty-three billion dollars a year, is paid due to ageism.   Experts Vs. Impressions Of The Public Related To Aging   Public perceptions about older adults are incomplete and unrealistic. We see issues where people have their own biases—our own internalized biases about aging. We might hear people say, "Oh, I have this pain in my back. It must be because I'm getting old."  I believe that you have a pain in your back. I think that you are getting older. You are aging, but I don't think that the sole reason that you have this pain in your back is that you're old. So you must get to your health care professional and get it checked out.   Ageism Is Not Considered A Problem   We hold implicit, subconscious biases as well as external and internal biases. Most people don't recognize ageism as a problem at all. It's the only "ism" that's socially accepted, and it's self-imposed of all of the "isms," and it's the only one that we're all doing together. Broader Public Pushes Aging Away Vs. Experts Who See Aging As A Possibility. People don't think about ageism because we don't think aging is just part of us. So, where experts might think that aging is something we embrace, the public tends to push aging away.  Interestingly, during interviews with people, you see people in the interview asking them questions about aging; you notice the push away. So it's not just the verbal cues; it's the non-verbal cues as well about aging that we need to think about. “When you don't know what to do, you tend to do nothing, so nothing changes. Aging is not all pessimistic; there are a lot of opportunities.” -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN But It's Not All Pessimistic.  The public has three significant patterns of thinking, which may be a bit more recessive cognitive patterns but we’ll learn to activate our communications when we understand them.  We Have Some Opportunities As Well:    Problems Can Be Solved.   We all believe that the problems can be solved and that comes out in a value of ingenuity. It comes out in the way that we build momentum. In the United States, we put people on the moon —so we can solve problems.   Collective Responsibility   In society, we have a collective responsibility for all. We see schools now where we have older people involved in pre-K and kindergarten programs. People of all ages are attending universities.  We see age-friendly movements. One of them is around university recognizing that you have an opportunity for a second, third career. That intergenerational opportunity of people interacting— that experience and knowledge that can be transferred is so important   What Surrounds Us Shapes Us   What's in our community helps us to recognize that we're all responsible for all of ourselves as we age. In talking about the social determinants of health, we think about do we have transportation? Do we have access to grocery stores? So those are the positive pieces that we want to cue. About Patricia D’Antonio, BSPharm, MS, MBA, BCGP: Patricia M. "Trish" D'Antonio, BSPharm, MS, MBA, BCGP, is GSA's vice president of professional policy affairs. In this role, she is responsible for managing the Society's relationships with other organizations in the aging arena, leading major Society programs and projects, and developing a strategy for future growth of the National Academy on an Aging Society (GSA's nonpartisan public policy institute). She is also the project director for the Reframing Aging Initiative, a long-term social change endeavor designed to improve the public's understanding of what aging means and the many ways that older people contribute to our society. About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as an FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.  

Aug 17

23 min 49 sec

We have a lot more control over aging well than most people think. Successful aging can be attributed to a wide range of habits that are modifiable - meaning if you have don’t have  healthy diet or don’t exercise, you can begin to make small changes over time that will improve your overall health. It’s never too late to get started. In this episode of Dr. Melissa Batchelor's This Is Getting Old: Moving Towards An Age-Friendly World, powerhouse healthy-aging advocates, authors, and speakers Bob and Fran German share their healthy-aging journey and discoveries.    They share their Top Five Strategies to be young at any age and live your best life—full of excellent health, energy, and boost your own happiness. Part One of 'Five Tips For Aging Well.' Bob and Fran’s Stories Fran's Story Bob and Fran were a typical couple until 1992, when Fran was 52 years old. She was diagnosed with a severe autoimmune disease called Myasthenia Gravis— an illness that causes severe muscle weakness. They went to 11 different neurologists to try to find a way to cure the incurable disease. Every doctor gave her that same pitch, and she'd never get better on it.  But Fran was stubborn, and she wanted to find a way to get better. "I took excellent care of myself. Changed to a whole foods plant-based diet, and cut out all animal products. Within a short period, I was off all medication, and I was symptom-free. Fifteen years later, the incurable disease that was supposed to shorten my life never reared its ugly head again." shared Fran.  Bob's Story Bob always tries to keep his body in good shape. He's slim and enjoys walking, running, and keeping fit. Until one day, he started to develop discomfort in his groin. Bob went to a urologist, and they found a tumor outside his left kidney.  Bob and Fran traveled to the Duke University Medical Center and had the tumor removed. Post-operation, the doctor told them that it was a cancerous growth—kidney cancer, renal cell carcinoma.   According to Bob, "The one thing the doctor had mentioned was even though he got the tumor, he said this type of cancer is known to return. That also was an impetus for me to change." “After we both have that devastating, life-threatening illness, we changed our lifestyle to a much more healthy one.”  Bob German, Healthy-Aging Advocate, Author, and Speaker How Their Lives Got Better By Making a Few Changes  Bob and Fran changed their eating and sleep habits. They also do their best to develop techniques to lower stress, which is often a precursor to illness. On top of that, they did a different type of exercise regimen and learned some strategies for building and strengthening their energy.    "Now, here we are in our 80s, and honestly, we feel better than we ever have in our life. We do have endless energy. It is fun." says Fran and Bob. Bob and Fran are in their 80's but they…. Have more energy than their 22-year old granddaughter.  Hike mountains in North Carolina. Authored a book, "101 Ways To Be Young At Any Age!" Lived in Thailand part-time for nine years & Fran cooks fabulous Thai dishes. Taught at the Buddhist University for six years. Founded an anti-child trafficking organization. The oldest-newest YouTubers ever in their 80's! Part Two of 'Five Tips For Aging Well.' With all those rough and rocky roads Bob and Fran have been through, not to mention the devastating, life-threatening illness, they've made it a goal in life to die young as late as possible. In line with that, their mission is to get people to come on this journey with them. For starters, here are the Five Tips for Aging Well from Bob and Fran.  Five Tips For Aging Well    EAT LIKE YOUR LIFE DEPENDS ON IT!   Every bite of food that you take either feeds illness or fights it!  Eat as your life depends on food—because it does. We believe that we should use the power of food to make the right choices. We encourage people to increase the whole foods they consume and reduce processed foods and animal products. Not only is it suitable for people, but it's ideal for the planet.     KEEP MOVING!   Sitting is the new smoking!   People don't get out, and they watch TV way too much. Bob says that you have to get off your "butt" and your "buts." You have to change your mindset on exercise and do exercise every day, preferably in the morning. We advocate even designing a little regimen that we call "The Hour of Power." So every morning, this would include some easy stretching and aerobic exercise, like walking briskly and walking for maybe 20 to 30 minutes. Moving is so essential not only to your physical well-being but also to your emotional well-being.  “Without the right mindset about ageism, you can shorten your lifespan for an average of seven years or more.” -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN   REDUCE STRESS   Do anything possible to reduce stress levels that you may be experiencing. That means considering taking on some mindfulness practice.  Your mind should be on the present moment; it's focused on the attention of what you are doing right now. Too many times, our mind drifts away. It glides into the past, where we think about things that have happened that aggravates us or gets us angry. Other times we think about things in the future that we worry about. That's human nature, but those are stressors: anger and worry. They immobilize you, and they stress you out—very unhealthy.  Take on meditation every day. Sit quietly for 5 to 10 minutes, at least once a day, and focus on your breath. Just breathe easily. You can sit in a comfortable place. No electronics, no TVs going. Just sit in a quiet room and relax your body and clear your mind. It will do wonders for you and lower your stress.    PRACTICE QIGONG FOR ENDLESS ENERGY     Qigong is an ancient Chinese system of wellness. You can Google it or go to our YouTube channel—" Young At Any Age." We have 40 different Qigong lessons that you can follow along. There's nothing to memorize, and it's effortless. Anybody could do it, and you could do it either sitting or standing, simple movements that help energize you and lower stress at the same time.     MAKE SLEEP A PRIORITY   It's often said that as you get older, you don't need as much sleep—that's not true. It's beneficial to get seven to eight hours of sleep each night because this is when your cells regenerate, and it helps your mood, mental sharpness, and physical well-being.  Your bedroom should be used only for two things—sleep or sex. It should be dark, calm, quiet, and no TV or computers in the bedroom. It's also advisable to avoid things that would prevent you from sleeping, like caffeine or alcohol, or sugary foods before bedtime.  Connect with Bob and Fran through these useful links: ❤️ Bob and Fran's Healthy-aging YouTube Channel: https://bit.ly/3c9om3T   ❤️Buy Bob and Fran's book, "101 WAYS TO BE YOUNG AT ANY AGE!" at  https://amzn.to/3a9g6Q0. ❤️ Visit Bob and Fran's website: https://www.bobnfran.com/. ❤️ Email Bob and Fran at bobnfran@gmail.com ❤️Visit Bob and Fran's ACT Project Website: https://bobnfran.wixsite.com/actproject. ABOUT BOB & FRAN GERMAN: Healthy-Aging Advocates, Authors, and Speakers. Bob and Fran are now both in their 80's and say that they feel Better Than Ever! They have enjoyed an incredible life together, a wonderful family, successful careers, worldwide travel, and countless adventures. And thankfully, they both overcame life-threatening diseases (kidney cancer and Myasthenia Gravis).  For years they have spent most of their time inspiring others to join them in their life goal to "Die Young, As Late As Possible" by making the right lifestyle  choices to get them to that goal. About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as an FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.  

Aug 10

30 min 50 sec

Are businesses in your city going the age-friendly path? If they are not, they make up the many companies worldwide that are missing out on this crucial initiative that supports and benefits senior consumers. In this episode, I provide essential yet often forgotten things that businesses should include in their spaces to accommodate the needs and ensure the continued patronage of older adults. It makes common sense that the more comfortable an establishment is for older people, it will also be comfortable for others. An age-friendly business means it's friendly for EVERYONE. -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN Key points covered in this episode: Tip #1: Readable Receipts. Normal aging causes presbyopia - which is farsightedness caused by loss of elasticity of the lens of the eye, occurring typically in middle and old age. With things opening back up in a post-COVID world, I can't tell you the number of people my own age who get their check, and they're like, "what does that say?! So we need a better process and format for receipts! Tip #2: Adapt Service to Improve Hearing. My friends and I frequently go to The Wine House for wine tastings. Typically, the sommelier stands in the middle of the room and discusses the wines, but the people at the tables can't hear a word being said - and what happens when people can't hear you? They start talking to themselves, resulting in more chatter and background noise. In activities such as this, it is best to invest in a system with a microphone and use overhead speakers and ensure an excellent experience for your customers. Tip #3: Increase and Contrast Menu Font. Use a white background with dark, bold lettering that's at least a 12 to 14 font size (at a minimum). If you can have an iPad or any type of device where people can magnify and make the font as big as they need it to be, it is advisable. Tip #4: Use Technology to Improve Accessibility. Another way to have an age-friendly menu is if you're able to use some electronic device that has a text reader option. This would also allow for greener updates to the menu and use of multiple languages for diverse customers. Tip #5: Have a Magnifying Mirror in Your Bathroom. One of the things you need to do before you leave the restaurant is to make sure you don't have anything stuck in your teeth or that your hair/ makeup are good to go! A magnifying mirror with a light on it in the bathroom will help people see and check themselves out before they go out the door! About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/

Aug 3

3 min 57 sec

Age is just a number. But in the workplace, your age can have a negative impact - maybe you were passed over for that promotion because your boss thinks you’re “too young”. Or maybe you feel that you weren’t hired for a position because the organization implied you were “too old”. Either way - this is ageism and we need to be more aware of it so we can address it. In data released by the Bureau of Labor Statistics, it is predicted that by the year 2024, workers aging 55 and older will represent 25 percent of the United States workforce. This trend will permeate many industries - and requires developing policies and protocols against stereotyping and age-related discrimination for people of all ages. In this episode of This is Getting Old podcast, I share the screen with investor, performer, media entrepreneur and "professional mom to startups" Randi Zuckerberg and engage in an insightful conversation on ageism in the workplace. Key points discussed in this episode: ✔️ The truth about aging women in tech. The culture continues that tech startups are mainly for young people. ✔️ Why starting a business late in life can be an advantage. Despite the industry being youth-centric, Randi posits that instead of feeling insecure about that, entrepreneurs should think of that as a competitive advantage with wisdom and experience to lean on. "You have such a bigger Rolodex at age 40 than you had at age 20 of contacts who you could hire or work with or partner or raise money from." ✔️ Seniors have high spending power. Women at 65 and older are the cornerstones of purchasing decisions in many households in an age where they have disposable income from their career, and they're using it. According to Randi, this age group is also driving so much tech adoption and the fastest growing demographic on social media. "I think it is a smart business decision to think about that woman as your customer. And I think more businesses are getting savvy to the fact that not only can they not ignore that customer, but they should also focus a lot of their efforts on her." Connect with Randi Zuckerberg Randi likes to call herself "a professional mom to entrepreneurs" because nothing gives her greater joy than working closely with startups and founders. Through her company, Zuckerberg Media, she has created award-winning content and experiences that educate families and bring to light digital literacy and safety issues. She is the best selling author of four books, producer of multiple television shows and theater productions, and hosts a weekly radio show on SiriusXM. Randi has been recognized with an Emmy nomination, two Tony Awards, a Drama Desk Award, and a Kidscreen Award. Before founding her own company, Randi was an early employee at Facebook, where she is best known for creating Facebook Live, now used by more than two billion people around the globe. When she's not Facebooking or actual written-word booking, she can be found at the theater, on the golf course (newly obsessed golfer,) travelling the world (physically or virtually) to speak at conferences or doing her best to unplug at home with her husband and three children. Instagram: https://www.instagram.com/randizuckerberg/ LinkedIn: https://www.linkedin.com/in/randizuckerberg Facebook: https://www.facebook.com/randizberg Twitter: https://twitter.com/randizuckerberg ______________________________________________________________________ About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Jul 27

9 min 2 sec

That moment comes in the life of married couples when the other half may begin to experience memory issues. Typically, this will change the dynamics of the marriage itself because the person who's experiencing Alzheimer's or dementia will not function in the way they used to.  In this episode of This is Getting Old podcast, listen if you are struggling to handle a spouse or a senior loved one repeating themselves a lot, or maybe they're stuck on a specific story that they're telling.    Key points covered in this episode:  ✔️ When the couple still retain their cognitive ability, and the other person can still get around, splinting allows assisting a person living with a memory problem by having the partner help and do things for them.   ✔️ Working through repetitive verbalization. If a spouse or someone is saying to you, "I want to go home", many times, rather than getting frustrated with them telling you the same thing repeatedly, respond with: "it seems to me that you're nervous or are you scared of something?" Asking them this question focuses on what they're truly feeling rather than what's being said.    ✔️ Address the underlying emotion. After you identify the cause beyond the intent, the best way to handle that is to help them work through the feeling so that you can hug them or comfort them and meet the underlying emotional need.    If you have questions, comments or need help, please feel free to drop a one-minute audio or video clip and email it to me at melissabphd@gmail.com, and I will get back to you by recording an answer to your question.    About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN:   I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.  

Jul 20

3 min 47 sec

Transportation Options for Older Adults: NV Rides with Jennifer Kanarek "One of the best ways to get people interested in caring for older adults is to have a positive experience—NV Rides volunteer driving program does just that." -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN ______________________________________________ When you're young and you got your driver's license, driving yourself from place to place was an entirely new level of independence. Losing the ability to drive as we grow older can happen for a lot of different reasons (and is not a normal part of aging), but usually is due to disabilities that occur due to many different chronic conditions that impact vision, hearing, and movement. (See my episode on Five Signs it’s Time to Take the Keys with Alzheimer’s disease for more information on what it takes to be able to drive if you are experiencing memory problems). Whenever anyone has to give up their keys—it's an automatic loss of independence. There are options to help people get around - we will go over those and talk about a unique and innovative volunteer program called NV Rides. NV Rides fills in a major gap that public transportation, carpooling, Uber, or Lyft options can’t provide — NV Rides partners volunteer drivers with older riders to provide door-to-door OR door-through-door transportation to a wide range of activities - from medical appointments to social events. Today we're privileged to have Jennifer Kanarek, MSW, the Program Manager of NV Rides, to share this fantastic program and transportation options for the older adults and our under capacitated fellows. NV Rides partners volunteer drivers with older riders to provide door-to-door OR door-through-door transportation to a wide range of activities - from medical appointments to social events. Today we're privileged to have Jennifer Kanarek, MSW, the Program Manager of NV Rides, to share this fantastic program and transportation options for the older adults and our under capacitated fellows. Part One of 'Transportation Options for Older Adults: NV Rides with Jennifer Kanarek' According to the National Association of Area Agencies on Aging, about 600,000 older adults stop driving each year. This makes it hard for older adults to make doctor's appointments, get to the grocery store, shop for necessities, visit family members and friends, or attend social events. More importantly, not having transportation increases social isolation, which can have adverse health outcomes and impact overall well-being. Interestingly enough, transportation is one of the most significant responsibilities for family caregivers. In fact, about 40% of caregivers spend at least five hours a week providing or making transportation arrangements. I know this to be true with my children and have long driven the #MamaTaxi! Read the full blog at: https://melissabphd.com/podcast-blog/

Jul 13

25 min 3 sec

"More than 40% of people over 65 years old misperceive that Medicare covers long-term care." -Marc A. Cohen, PhD Long-term care is care across a range of settings and can include medical and non-medical services that assist individuals who cannot care for themselves for extended periods. Also, long-term care is often provided at a person's home, largely by family and friends. Thus, it's a challenge to discern whether you even need long-term care insurance coverage. If you can afford this type of policy, it's even harder to know if the insurer and the policy will still be there with adequate coverage whenever you need it. In this episode of This Is Getting Old, Marc A. Cohen, PhD., will talk about the basics of how long-term care is paid for now - and discuss future trends for the long-term care insurance industry. Part One of “Do I Need Long-Term Care Insurance? And Future Trends” How Is Long-term Care Currently Financed? Long Term Services and Supports (LTSS) are services designed to help people with functional incapacities, limitations, or cognitive issues. These circumstances limit a person’s ability to perform basic activities of daily living like bathing, dressing, toileting; all the things that one would need to be able to do in order to live independently. Unlike acute medical care, with services like hospital care, physician care tends to focus on curing people of specific ailments; long-term services and supports are designed to help people living with chronic illnesses maintain their function or reduce the decline in functioning over time. In today’s market, long-term care is financed in three major ways: ✅ Out-of-pocket: Disabled older adults and their families pay out-of-pocket for care. ✅ Medicaid: A federal-state social safety net program. Older adults must qualify for Medicaid by meeting very low income and asset thresholds. ✅ and private long-term care insurance. Is Private Long-term Care Insurance Still And/Or Going To Continue A Valuable Product For Consumers? The long-term care financing problem in the United States is enormous. People over age 65 today, around twenty-five million of them will require long-term care services and supports projected to cost trillions of dollars; including family support provided care, which is not often evaluated. When we look at the dollars spent and put a dollar value to the care provided by families, it's more than seven times what our public program, Medicaid, pays. So given that the bulk of care is provided by families, we have these situations now, where the caring family network is stretched. We used to talk about the “Sandwich Generation” - where you had an older adult caring for an elderly parent and a school-aged child— Dr. Cohen now calls this the “Panini Generation”. In other words, paying for and providing long-term care can create a situation that crushes families. Given these circumstances, we need to have more financial resources flowing into this system. The problem is so big that no one sector can handle it on its own. That means that we can't fully publicly finance long-term care —and we've already proven that it can't be a privately owned, privately funded solution. Therefore, we need roles for the public and private sector in order to find a viable solution. Part Two of “Do I Need Long-Term Care Insurance? And Future Trends.” Can Long-term Care Insurance Still Play A Meaningful Role In Addressing The Challenges Of Long-term Care Financing? And What Public Policies Need To Change For Long-term Care Insurance To Remain A Viable Product? We've seen in the private market that private insurance companies can no longer handle that “catastrophic risk” that is called “long-tail risk” or “long-term risk”. Another one is that the private insurance industry is much better at handling folks who need care for one, two, three, four, maybe five years, but they get in trouble with rating agencies who think that they're taking on uncapped liabilities. With that, the private sector has stopped providing coverage. So the long and the short of it is that each financial option has a clearly defined role. The private insurance sector has to worry about developing insurance products that will work based on their terms. The public sector takes on the predominant part of the risk—the catastrophic. The idea is that by doing that, older adults can put together a package of comprehensive insurance that starts with the private sector and moves to the public sector. "It's no longer an accident that we live long lives —we expect to live long lives, but that brings functional impairment and cognitive impairment levels that we haven't seen. And because the long-term care financing problem necessitates bold action, it's going to require bold action." -Marc A. Cohen, Ph.D A Catastrophic Public LTSS Insurance Program Can Significantly Help The Market Thrive And Meet America's LTSS Financing Challenge. The notion of “catastrophic public long-term services and support” is an idea that proposes financial help would be variable, depending on your economic circumstance. For example: ✅ If you're lower middle class, the public program would pay after you need care for one year. ✅ If you are a little bit wealthier, you would pay for the first two years with your savings or insurance, and then the public program would kick in. ✅ And if you're wealthy, then potentially you have to worry about the first four years of care, and then the public program provides coverage. What's nice is there are a couple of good things about this scenario: ✅ First of all, when you have a well-defined public role, it will help people understand, "Oh, I've got some personal accountability or responsibility for worrying about whether it's one year, two years, or three." ✅ Number two is about how the middle-income folks accessed Medicaid because they spent down their income and assets. Well, if you have an insurance solution for those folks, that means you have fewer claims on the social safety net. This further means that states will have some pretty significant savings to their Medicaid programs. So it'll be relatively attractive to states and the people accessing Medicaid—people for whom there are no insurance alternatives and no savings alternatives. ✅ The third thing that it does is that it will stream new money into the system. All of us know what happened during the pandemic, especially in the beginning when the pandemic ravaged elders in nursing homes in particular. Part of the issue is that we have underfunded the entire long-term care system. So there has not been enough money to support levels of wages that we need to attract and keep people working, develop career ladders, pay for high-quality care and safety. A public insurance program with private insurance filling in the gaps and savings will stream more money into the system and will have everyone benefit from a better system. Congress.gov will have information on The WISH Act proposed by Rep. Tom Suozzi (D-NY-3) shortly! About Marc A. Cohen PhD Marc A. Cohen, Ph.D. is a Professor of Gerontology at UMass Boston and the Co-Director of the LeadingAge LTSS Center @UMass Boston. He is also a Research Director at the Center for Consumer Engagement in Health Innovation at Community Catalyst. Before joining UMass in 2016, Dr. Cohen founded and led LifePlans, Inc., a long-term services and support (LTSS) research and risk management company. Over his 30 year career, Dr. Cohen had conducted extensive research on LTSS financing and delivery issues, testified before Congress, served on an appointed Massachusetts' LTSS financing task force, and chaired a study panel on designing state-based LTSS social insurance programs. He has been quoted extensively by major news outlets and is viewed as a thought-leader on issues affecting eldercare financing. He received his Ph.D. from the Heller School at Brandeis University and his Master's Degree from the Kennedy School of Government at Harvard University. Connect With Dr. Marc A. Cohen through the following social media platforms: Twitter: @UMassBoston @LeadingAge @CCEHI @CommCatHealth Facebook: @UMassBoston @communitycatalyst @LeadingAge Instagram: @UMassBoston @LeadingAge For more valuable resources, check out the episode of Elder Care: Past and Future with Joanne Lynn, MD, MA, MS, and Carrie Graham, PhD, MGS.  Watch the full episode here: https://youtu.be/4S8ongyzMco About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as an FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Jul 6

41 min 32 sec

Bladder Infections: To Treat or Not to Treat in Older Adults? “Asymptomatic bacteriuria in long-term care is more common than actual Urinary Tract Infections. About 35 to 40% of men and about 50% of women in long-term care have it—that's even higher for women with urinary incontinence.” -Jamie Smith, MSN, FNP ____________________________________________________________________ When someone is aged and frail, the risk of a bladder infection is higher, raising the chances of delirium, hospital admission, or even death. In this episode of This Is Getting Old: Moving Towards An Age-Friendly World, Jamie Smith, a Family Nurse Practitioner in geriatrics and nursing home care, describes bladder infections and things you and healthcare professionals should know about helping the older adults decide whether or not to treat with antibiotics. Part One of 'Bladder Infections: To Treat or Not to Treat in Older Adults?' What Is A Bladder Infection? A Urinary Tract Infection (UTI) a bacterial infection within the bladder. It's an acute illness that affects the genitourinary system and is commonly known as a “bladder infection” - and means you have an infection of your genitourinary system, so your bladder, kidneys, ureters or urethra with a “positive urine” with a urine sample. The typical symptoms include: burning sensation with urination, abnormal urgency and frequency in urination. In addition, you may have severe pubic pain or “gross hematuria” (where your pee turns different colors like pinkish or reddish). Asymptomatic Bacteriuria (ASB), also known as a colonized state. ASB is where you have a positive urine sample, but lack the typical genitourinary symptoms that go along with a UTI. The presence of bacteria in ASB is in quantitative counts of ≥ 100,000 colony-forming units/milliliter (CFU/mL) or ≥ 100 CFU/mL in a catheterized specimen. Thus, in the absence of urinary tract symptoms, asymptomatic bacteriuria is determined by white blood cells in the urine. "It's critical to differentiate between UTI and colonized state because when you give antibiotics to older adults, that increases their risk of antibiotic resistance, drug to drug interaction, and increased health care cost." - Jamie Smith, MSN, FNP. To Treat or Not To Treat? Telling the difference between a UTI and ASB is tricky in older adults, especially those in long-term care facilities because localized genitourinary symptoms are far less pervasive in them. Consequently, there have been differences in treatment protocols from place to place regarding a bladder infection. ✔️ Differences in Protocols For Treatment at ER/ Hospital vs Long-term care settings Whenever a family member requests a patient to go out because they're confused about whether it's a UTI or ASB, one of the first things the ER does is check a Complete Blood Count (CBC) and a Basic Metabolic Panel (BMP). Even if the urine has trace amounts of bacteria, let's say the patient is confused that they can't tell if there are any genitourinary symptoms, the ER will typically go ahead and prescribe an antibiotic. ✔️ Protocols for Treatment at Skilled Nursing Facilities or at Home Bladder infection treatments are different in long term care facilities or at home because the staff or family members can tell if the older adult is having symptoms. If the older adult is not having any symptoms associated with the urinary tract, that's classified as colonized. We don't treat colonized states because we look at Loeb's or McGreer's Criteria, and if they don't qualify, we don't treat them because of the risk of harm by giving them an antibiotic. Risks of Harm in Older Adults It's imperative to differentiate between UTI and ASB (colonized state). Because when you give antibiotics to older adults, that increases their risk of Clostridium difficile (C. diff), antibiotic resistance, a drug to drug interaction, and increased health care cost. Part Two of 'Bladder Infections: To Treat or Not to Treat in Older Adults?' Role of Cognition in Treating Asymptomatic Bacteriuria Remember that treating ASB is not always straightforward. Long term care patients sometimes will have a cognitive impairment, and they can't always tell you if the symptoms are there. There are several tools that you can use. The AMDA Watchlist, for instance, is a urinary tract infection flip manual. This one-pager watchlist can be used by staff or family members, and it helps care providers figure out if it's a UTI or colonized state. Read the full article at www.MelissaBPhD.com/podcast-blog

Jun 29

8 min 4 sec

"Atypical Presentation of Illness when an older adult has an illness or condition that doesn’t show up in the typical textbook definition/ ways." - Jamie Smith, MSN, FNP “Mrs. Jones just isn’t ‘right’ today”. Subtle, non-specific changes in an older adult may be the first sign that family members and caregivers see when an older adult is developing an illness. In today’s episode, we will talk about how changes in mental status (hypo- and hyperactive delirium) can be the first sign of an infection, how some infections are show up differently for younger and older adults (e.g., bladder infections), and how depression shows up differently for younger and older adults. Jamie Smith MSN, FNP, in this episode of This Is Getting Old: Moving Towards an Age-Friendly World, highlights some salient points on how to recognize atypical presentations of illness among older adults. Part One Of 'Atypical Presentation Of Illness In Older Adults'. What Is Atypical Presentation Of Illness? Conventional healthcare education teaches the typical symptoms of common illnesses. However, for older adults, these common illnesses do not show up in the same way. The symptoms are usually subtler and less specific than in younger adults and often are first noticed as a change in mental status, energy level or function (such as a fall or a new onset of losing control of their bladder (incontinence)). Atypical Presentation of Illness means that an older adult will have little or no typical signs and symptoms that usually indicate a specific illness or diagnosis. Failure to investigate atypical presentations in older patients, and identify the true medical problem, may result in undesirable outcomes, inaccurate diagnoses, and the wrong treatment for the illness. Delirium is one way an illness may show up (or “present”) and has been attributed to adverse health outcomes. The Seriousness Of Deliriousness: Delirium In Older Adults What is Delirium? Delirium usually develops quickly in a matter of hours or days. Thus, healthcare providers should be well aware of the signs and symptoms of delirium. Doing so may help them recognize atypical presentations of illness and at best help curtail severe medical conditions. Delirium is characterized by a sudden change in attention, awareness, and cognition. Delirium may be hypoactive (meaning the person may be more tired or sleepy than usual but the changes in behavior are subtler) or hyperactive (meaning the person is trying to crawl out of bed or some other active, agitated behavior). Accurately diagnosing delirium in a patient population prone to dementia, depression, fatigue, and other conditions whose symptoms can mirror those of delirium can be challenging. It is estimated that between 32-66% of delirium cases are missed by healthcare professionals. This failure to diagnose delirium has two significant consequences for patients. ✅ First, the patient is presumed to have a condition, often dementia, that they do not have, which leads to false assumptions about prognosis and the possible ordering of inappropriate treatments. ✅ Second, and of equal importance, missing the diagnosis of delirium may cause clinicians to fail to investigate its underlying medical causes. Delirium may indicate a life-threatening condition. It carries an increased risk of functional decline and falls, cognitive decline, recurrent hospitalizations, and mortality. In addition, it can take months to clear, and some older adults may never regain their prior functional level. What does Hypoactive Delirium look like? Symptoms Of Hypoactive Delirium Hypoactive delirium is often missed because it doesn’t create a problem for others - basically, this type of delirium is characterized by reduced motor activity, sluggishness, seeming to be in a daze, lack of interest in anything, and reduced alertness. Symptoms in older adults include: ✅ The person "isn't right" – a sudden change in thinking/ mental status, tired (lethargic), staying in bed. ✅ May or may not have a fever ✅ Change in baseline vital signs (heart rate, weight loss, change in appetite) Things that can cause hypoactive delirium include: ✅ Constipation ✅ or an underlying infection Symptoms Of Hyperactive Delirium Hyperactive delirium gets attention! This type of delirium is characterized by increased motor activity, wandering hyper alertness, rapid speech, irritability, and combativeness. Among older adults, common symptoms include: ✅ Behaviors are trying to get out of bed, fighting, fluctuating mental status. Read the full article at www.MelissaBPhD.com/podcast-blog  

Jun 22

14 min 44 sec

I’ve taken care of thousands of older adults living with Alzheimer’s disease and ultimately dying either with or from this devastating disease. I hope the information in this podcast will help you to be prepared as your loved one moves through each stage of the disease. There is some variation in what different people think are the Stages of Dementia. I am of the mindset (pun totally intended) to keep things simple – so I think of this disease in 4 stages: Early-, Middle-, Late- and End-Stage; or Mild, Moderate, Severe and ultimately the dying process. Late-stage Alzheimer’s – or Severe At this stage, the person is going to have severe symptoms and rely on others for all care. They lose the ability to carry on a conversation, respond to their environment, and eventually lose the ability to control movement. Common symptoms or difficulties in this stage include: ✔️ Difficulty communicating with words; which leaves their behavior to tell us what they might need. ✔️ Requiring around-the-clock assistance ✔️ Lose the ability to walk, sit and eventually they will have a hard time swallowing. In fact, nearly 80% of people in late-stage dementia will develop some form of an eating problem. ✔️ And because of the swallowing problems, they are at a higher risk for aspiration or bladder infections In the late-stage of this disease, the person will likely have trouble initiating engagement with you or their loved ones, but they still benefit from interacting in ways like listening to music together, singing, or receiving assurance through gentle touch. This is the time for caregivers to explore community services and supports like palliative and/or hospice care. If/when the time comes and your loved one is having trouble swallowing, I recommend working with a Speech Therapist to determine the best type of diet. This may range from mechanical soft foods to pureed and some level of thickened liquids to minimize the risk of aspiration. You should also seek the support of a local palliative care provider to help guide you through the end-of-life that is inevitable with this disease. No one has ever survived Alzheimer’s disease. That means it is terminal illness – and you will either die with Alzheimer’s disease - or from it. It is a highly emotional time for loved ones, but when you die from Alzheimer’s disease, your loved one will not starve to death – they will die from Alzheimer’s disease. Think about how nature handles death. Many forms of life stop eating and drinking when death is near, and this is not a painful process. Feeding tubes are not recommended in Alzheimer’s disease because it is a terminal disease. Evidence has shown that feeding tubes don’t do the things that most families wish they would: They do not decrease a person’s risk for aspiration or infection; they don’t improve quality of life, in fact, they are often pulled out which results in a trip to the emergency room or being hospitalized. It’s not natural to have a tube hanging out of your body and when your brain has failed, you don’t understand what it’s doing there and it’s natural to try to pull it out. If you find yourself in the situation of having to make a decision about a feeding tube, I’d like for you to learn more about handfeeding. Handfeeding is recommended over tube feeding until death. Offering supportive handfeeding using three different handfeeding techniques allows you to connect with your loved one - and offer food and fluids in the safest way. You can learn more about the handfeeding techniques by checking out my video titled “How to Help a Person with Dementia to Eat”. End-Stage Alzheimer’s Disease – The Dying Process At a certain point, your loved one will enter the dying process. In this final phase of life, you will want to have a palliative care or hospice provider guiding the care of your loved one. Here are criteria that are generally used to mark End-stage Alzheimer’s disease. At this point, your providers should be asked if they would be surprised if your loved one passed away in the next six months. A life expectancy of six months or less, along with these other key symptoms typically mean the person has transitioned to dying. ✔️ They are bedridden, meaning they are no longer able to walk or sit upright ✔️ Total loss of control of both their bowels and bladder ✔️ Difficulty swallowing or choking on food or fluid ✔️ Weight loss or dehydration due to the challenges of swallowing when eating/ drinking ✔️ Not able to speak more than six words per day ✔️ Another chronic condition such as congestive heart failure, cancer or COPD. ✔️ An increase in trips to the emergency room or hospitalizations ✔️ A diagnosis of pneumonia or sepsis Alzheimer’s disease is one that makes us all take one day at the time and live in the present. It can be a very long process, so I hope this information and recommendations for finding support have been helpful.

Jun 15

8 min 35 sec

Welcome to This is Getting Old: Moving Towards an Age-Friendly World, I’m your host Melissa Batchelor, and today I’ll be talking about What are the Stages of Alzheimer’s Disease? I’ve taken care of thousands of older adults living with Alzheimer’s disease and ultimately dying either with or from this devastating disease. I hope the information in this podcast will help you to be prepared as your loved one moves through each stage of the disease. There is some variation in what different people think are the Stages of Dementia. I am of the mindset (pun totally intended) to keep things simple – so I think of this disease in 4 stages: Early-, Middle-, Late- and End-Stage; or Mild, Moderate, Severe and ultimately the dying process. The stages are helpful for understanding the overall picture of what to expect with a person’s ability and should be used as a general guide. I see people all the time trying to peg a loved one into one of the 7 stages and wants to know if the person is leaving Stage 4 and entering Stage 5. At the end of the day, you are going to have to adapt the care provided to the moment and the person in front of you, regardless of stage or progression. There’s often a lot of overlap and I recommend you don’t get caught up in the specific stages – even if you’re using these three. Here’s what we know about Alzheimer’s disease – it’s a progressive, neurodegenerative disease, meaning your brain fails over time. When your brain fails, that means your ability to do anything for yourself is going to fail by time you get to the Late-Stage. How quickly a person deteriorates varies – and can range from 4-8 years, and up to 20, depending on how healthy the person is otherwise. Early-Stage Alzheimer’s – or Mild In the early stages, a person may be able to function pretty independently. They may be able to drive familiar routes, work, and participate in social activities. The symptoms may not be very apparent at this stage, but family and close friends may notice some changes such as forgetting familiar words – See my Podcast on the Ten Warning Signs – or where they put things. Common symptoms or difficulties in this stage include: ✔️ Trouble remembering names when introduced to new people ✔️ Coming up with the right name or word – particularly nouns ✔️ Losing or misplacing valuable or commonly used items ✔️ Have trouble with planning or organizing ✔️ Have difficulty performing tasks at work Middle-stage Alzheimer’s – or Moderate The middle stage is the longest stage and can last for many years. During this stage, the symptoms are going to be much more apparent, and the person is going to need a greater level of care. The person may get confused or angry or act in unexpected ways – like refusing to bathe. The person is going to have more trouble expressing thoughts, may confuse words or have trouble performing routine tasks without assistance. Common symptoms or difficulties in this stage include: ✔️ Being moody, think mood swings; especially in mentally or socially challenges situations ✔️ Will have much easier time recalling information from long ago and have more difficulty with short-term memory - meaning they can remember childhood or young adulthood memories but can’t recall what they had for breakfast. ✔️ They may be more confused about what day it is – or where they are. We lost our orientation to time first, then place, then person; meaning they will know who they are for longer than they know where they are or what year/ season they are in. ✔️ They may need help choosing clothes that are appropriate for the season or the occasion ✔️ Trouble with bowel or bladder; or may get their days and nights mixed up. ✔️ May wander more and get lost easier. ✔️ May have personality or behavioral changes – such as delusions, compulsiveness or suspiciousness or they may have more repetitive behaviors like wringing their hands or shredding tissues In the middle stages, the person can still participate in activities of daily living, like bathing, grooming or getting dressed, but they will need assistance. You should adjust the amount of care you provide based on what the person can do in the moment and simplify tasks if you can. Care will get more intense over time, so know what resources you have in your community like Adult Day Care or Respite Care so you can get a temporary break from caregiving while your loved one is in a safe place. Alzheimer’s disease is one that makes us all take one day at the time and live in the present. It can be a very long process, so I hope this information and recommendations for finding support have been helpful. Thank you for watching this video and/or listening to the podcast today.

Jun 8

7 min 29 sec

Alzheimer’s Disease and Living Alone: Four Signs Someone May Not Be Safe at Home Alone  Welcome to This is Getting Old: Moving Towards an Age-Friendly World, I’m your host Melissa Batchelor, and today I’ll be sharing Alzheimer’s Disease and Living Alone: Four Signs Someone May Not Be Safe at Home Alone – and what you can do about it. A lot of people have asked me what some of the signs are that a loved one may be experiencing memory loss, when the person lives alone or you don’t live close by to see them every day. When someone lives alone, it’s easier for them to cover up memory problems. You may have to get a trusted friend or neighbor to check on your loved one if you can’t be there in person. If you are concerned about someone living alone and whether or not they are in need of help, here are 4 changes you can consider and questions to think about: #1: Changes in Phone Calls:  When you talk on the phone, does the person ramble or repeat information? Does the person forget what they were saying, and are unable to pick back up on the train of thought when you provide a few details of what they were saying? Do they repeat the same story each time you call, as if it were new? Are you getting fewer phone calls from a person who usually calls you regularly? Or too many calls? Or maybe calls that are late at night or early in the morning? #2: Changes in Emailing or Writing: If a person was on social media or emailed you before, have they stopped doing that? When they write something, does it appear to be rambling that’s uncharacteristic of the person? If they send you a handwritten note, has their handwriting changed? #3: Changes in Personality or Habits: Has your loved one started to become uncharacteristically negative or pessimistic? Have they stopped going to social or family events, when they used to be out and about? Do they seem withdrawn or sad? More isolated? Are they neglecting themselves – so not showering or getting dressed? Not brushing their teeth or hair? #4: Changes with Meals or Medications: Maybe the person is missing medications or taking medications wrong. As a clinician, unplanned weight loss was often the first sign that a person was experiencing memory problems. They have been forgetting to eat or missing meals. When offered a hot meal, would they rather eat sweets? Do they forget to turn the oven or stove off when cooking?  What Can You Do? If you’re loved one is experiencing one or more problems in these 4 areas, it would be wise to consult with your primary care provider. They are likely not safe, or becoming not safe, to live alone. These signs may be indicative of a major safety issue, so better to address them sooner rather than later, to avoid severe or even fatal accidents. You can also contact the Alzheimer’s Association Chapter in your community or your local Area Agency on Aging. These two organizations will typically know who can help families who are providing care at a distance and can give you valuable information and connect you to services. Thank you for watching this video or listening to the podcast today. I hope these 4 Signs, questions, and recommendations have been helpful to you.   

Jun 1

5 min 55 sec

Alzheimer’s Disease and Driving: Five Signs that It’s Time to Take the Keys Welcome to This is Getting Old: Moving Towards an Age-Friendly World, I’m your host Melissa Batchelor, and today I’ll be talking to you about Alzheimer’s Disease and Driving: Five Signs that It’s Time to Take the Keys. There may come a time when you realize that your parent, or spouse, or loved one isn’t able to drive safely anymore. The tricky part is this delicate balance between allowing them to keep driving and knowing when to take the keys. In the early phase of Alzheimer’s disease, or dementia, many people may be able to continue driving familiar routes, say back and forth to the grocery store or the bank. For most “experienced drivers”, driving is a skill so well learned that it is partly “automatic”. The problem is going to come in when the driver needs to make a quick decision to avoid an unexpected hazard or situation. In fact, a common sign that a person is experiencing a problem with their thinking or memory is indeed a car accident. Some people will recognize that they are having more difficulty and give their keys up. Other people may fight you to keep the keys. If that’s the situation you find yourself, as a caregiver in, here are some things to have evaluated that can help you make an informed decision, rather than feeling like you’re being the “bad guy”. Here are the seven things you need to have evaluated. These things can be checked out by working with your primary care provider, seeing if there’s an occupational therapist in your area who evaluates driving skills, and/or your local DMV. #1: Good vision: Not only will the person need to have good vision, even if corrected by glasses. This includes not only short- and long-distance vision, but also peripheral vision. If you’ve listened to my podcasts before, you’ve heard me say that by the time a person is in their 70’s or 80’s, they will normally lose 20-30 degrees of peripheral vision. Being aware of this means you’ll need to be turning your head to check both ways when driving – even if you don’t have Alzheimer’s disease.  #2: Good hearing: Hearing is also another critical aspect of driving – being able to hear car horns, approaching cars, and warning signals. Wearing your hearing aids while driving, if you need them, is going to be important; or having your hearing evaluated to see if you need hearing aids. #3: Alertness to what’s going on around them: All drivers have to be alert to what’s going on around them, from multiple directions. Problems with memory or thinking may get upset or confused and/ or miss things in their surroundings if they are having to put all of their mental energy into looking at the road ahead. #4: Quick reaction time: Drivers need to be able to react quickly, to brake and/or avoid accidents. If you notice that your loved one is slow to react, slowed down, or seems to react to sudden changes inappropriately, it could also interfere with their ability to drive.  #5: Ability to make quick decisions: Drivers need to be able to make quick – and appropriate – decisions quickly and calmly. Making a correct decision when confronted with a sudden change, and doing so without panicking or getting upset may be another sign it’s close to time to take the keys. I’d recommend that if you are seeing a problem with any of these 5 things, to get the help of a provider, driving safety school or your local DMV. Rather than getting into a fight with your loved one, let one of these other people take on the role of the “bad guy”. This will take the pressure off of you, and they may listen better to a person in a position of authority – rather than thinking you are being mean or antagonistic. At the end of the day, the main job of anyone in a caregiving role for a loved one living with Alzheimer’s disease is to maintain the relationship and not get into a pattern of “resistance being met with resistance”. Thanks for listening to this podcast or watching the video – I hope these 5 things will help you know when it’s time to get help and take the keys to keep your loved one safe – and others on the road.  

May 25

6 min 6 sec

Nursing Homes During COVID "There are published checklists for how to determine the quality of care a facility can deliver. But most of that's gone out the window because COVID has changed everything."  -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN ____________________________________________________________________ As of February 2021, 35% of COVID-19 deaths in the United States have occurred among the nursing home population - and these deaths include residents and staff. For over a year now, family caregivers, volunteers, and/ or paid companions have not been allowed to enter nursing homes.  The pandemic highlighted many problems that already existed in our nation’s nursing homes, particularly related to staffing. Many facilities struggled with short-staffing prior to COVID - but COVID has amplified staffing shortages and residents are suffering; and some have died as a result.  Providing a paid Companion has always been one option for ensuring 1:1 care in a facility for your loved one. Although families do have to pay for this out-of-pocket, some facilities are still not allowing companions into the facility - over a year into the pandemic.  In this episode of This Is Getting Old: Moving Towards an Age-Friendly World, Kenya Beard,  Associate Provost for Social Mission and Academic Excellence at Chamberlain University, will share her experience of losing her Mom due to COVID while in a nursing facility. Part One of 'Nursing Homes During COVID'. It's difficult to lose someone you love while still dealing with the horrors and uncertainties of the COVID-19 pandemic. Kenya and her family went through then when their mom was infected with COVID during what was supposed to be a short-stay rehabilitation experience. Instead, she ended up dehydrated and hospitalized from her stay; and ultimately, died.  The Story Of Kenya's Mom: A Tale of How COVID Impacted Nursing Homes COVID took the whole world by surprise. We were not prepared, and it exposed a lot of leaks in the healthcare system and exaggerated other leaks that were already there.  The nursing home facility that Kenya's mom was in did not allow companions that the family was willing to pay for in order to get 1:1 care for their mother - they essentially tied their hands behind their backs.  It all started when Kenya's mom fractured her ankle. She had this injury treated and was ok for several years. However, she woke up one morning in early 2021 with horrific pain, crying. Kenya and her sister hesitated to bring her to the hospital because of the pandemic. But the pain was so excruciating that they were left with no other options and she was taken to the emergency room.  Unfortunately, from being in bed for so many days, Kenya's mom declined and deconditioned. Since her sister wasn't comfortable having a physical therapist come into the home (because she had a bubble that she wanted to protect and keep everyone else safe, too), they decided to allow their mom to go into a nursing home.  While in the nursing home, January this year, Kenya's mom tested positive for COVID. Kenya was very upset - because they assured her in the beginning that they had guidelines in place to protect individuals from getting COVID.  Here comes the sad part of the story, Kenya knew her mother needed assistance, and she felt that if the facility put her into isolation because of COVID, that would not get the care that she needed. So she asked the nursing home Administrator if they (the family) could hire a companion. The nursing homes’s Director of Nursing said, “Oh, I don't think we can. If you can find a facility for me that's doing it, let me know." "The nurse (in the hospital) held the phone for half an hour so we could see my mother. She never said, ‘I have to go. You guys have to wrap this up’ - she stayed with us on the phone all that time." —Kenya Beard, EdD, AGACNP-BC, CNE, ANEF, FAAN Kenya made phone calls over the weekend and asked several facilities about whether or not they allowed companions. She even reached out to the Department of Health (DOH) to verify the guidelines regarding companions for older adults in nursing homes. Although the DOH responded that they don't have some guidelines and it's up to the facility, they still refused to have a companion for Kenya's mom. Instead, they assured her that everything would be handled.  The next couple of days, Kenya received a call from the nursing home supervisor asking for permission to start an IV because her mother is dehydrated. When she got off the phone, Kenya called the Department of Health and filed a complaint. A few days later, they received a call that the facility was going to have to send her mom to the emergency room. Her sodium had come back at 167 and her mental status had declined.  Three days later, Kenya's mom died. Part Two of 'Nursing Homes During COVID'. Nursing Homes During COVID: Where Do They Need Help? The pandemic has put further pressure on the primarily frail nursing home facilities, which have long struggled with staff turnover, persistent personnel shortages, and elevated burnout. To safeguard nursing home residents from the pandemic's long-term effects, we must first consider how COVID-19 has impacted employees' day-to-day jobs and the areas where they need help.   Staffing Issues   While the effect of COVID-19 on older adults has received a lot of coverage, there has been even less reflection on how the pandemic has affected long-term care workers' careers and responsibilities. Short-staffed facilities resulted in poor resident outcomes, even death. COVID has put such stress on the staff. Even people that have worked on a long-term care corporation for 30 years are like, “I'm out of here. I can't do it anymore.”    Transparency For Allowing  Companions   Guidelines for allowing companions for older adults in nursing homes has not been required to be transparent for older adults and their  families during the COVID outbreak. Who suffers the most with these decisions to prohibit companions? The older adults.   State To State Variation On Guidelines And Protocols   Nursing home administrators have spoken about the difficulties in handling variations  in implementing COVID health safety protocols on top of adhering to the regulated rules and guidelines. Many administrators complained that policies from state authorities were ambiguous and inconsistent at times.  "If you are a skilled nursing facility, you are required to have one registered nurse on duty, 24/7."  —Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN   Corporation To Corporation Variation   Corporations primarily own nursing homes, and while they have to follow federal and state guidelines, the important thing to know is how each individual facility is implementing policies and procedures related to companions and visitation.    Individual Leadership Within A Nursing Home   Nursing home administrators and directors of nursing have been faced with incredibly trying times for the nursing home industry.  They have had to be flexible and try to balance the priorities of families, residents, and all the layers of regulation (federal, state, corporate office). Some individual leadership decisions have resulted in adverse patient care outcomes.  What To Learn From The Nursing Home During COVID Experience? COVID has taught us many lessons. The most important of which is to cherish the ones we loved more than anything else. COVID won't be the last pandemic or infectious disease that we're going to have to deal with in this country. So what lessons should we learn so the same situations won't happen again?  Know Your Rights, Know The Rules  The number one thing people need to know before they put a loved one in a facility is you have the right to ask if you can have a companion. Put your loved one in a facility that allows for companions if you cannot be there.  The pandemic has been going on for 14 months - it’s time to create better road maps for taking care of our older, most vulnerable loved ones. Now; and in the future. About Kenya V. Beard, EdD, AGACNP-BC, CNE, ANEF, FAAN: Kenya V. Beard, EdD, AGACNP-BC, CNE, ANEF, FAAN, is the Associate Provost for Social Mission and Academic Excellence at Chamberlain University. As a 2012 Macy Faculty Scholar, she propagated research and best practices that advanced the needle on diversity, inclusion, and health equity. She supported schools in the development of a multicultural curriculum that empowers all learners. In her former role as Senior Fellow at the Center for Health Policy and Media Engagement at George Washington University School of Nursing, she wrote blogs and co-produced health care disparity segments for the Center's radio program, HealthCetera, on WBAI-FM for an audience of over 400,000 diverse listeners. Her webinars, blogs, workshops, research, and publications speak to the critical need for authentic race-related discourse. About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

May 18

22 min 14 sec

Have you ever had a conversation with your healthcare provider about how the food you eat impacts your overall health? Historically, healthcare providers have not received training to have this conversation but Culinary Medicine is poised to change that. As the world’s most comprehensive curriculum for physicians, healthcare professionals, patients and community members, Health meets Food is changing that. Join us to learn more about how Health meets Food and the Culinary Medicine program from my guest, Dr. Timothy S. Harlan, MD, FACP. He's a Professor of Medicine in the Division of General Internal Medicine and Director of George Washington University's Culinary Medicine Program. Part One of 'Health Meets Food: Culinary Medicine. Food as a wellness tool isn't a novel concept. As a model of education, Culinary Medicine encourages people of all ages and backgrounds to transcend traditional obstacles to healthy eating and is a new take on medication. What Is Culinary Medicine? Culinary Medicine is a modern evidence-based discipline that combines the principles of medication with the creativity of food preparation. Culinary Medicine is a novel instructional and nutritional solution to changing dietary habits that focus on food shopping, food preparation, preservation, and meal planning. Why Is Culinary Medicine Necessary? What we ingest affects our health and wellbeing. The origins and variety of food you've eaten influence any of this. Numerous findings show that home-cooked meals and higher consumption of fruits and vegetables are linked to a healthy lifestyle. However, new research suggests that Americans are dining out more (at a 42% rate of increase) and cooking less at home (at a 25% rate of decrease).  "Programs at Culinary Medicine teach medical students, practicing physicians, nursing students how to cook, how to eat healthily, and how to have the conversation of healthy eating with their patient." Dr. Tim Harlan, MD, FACP  How Has Culinary Medicine Came To Be? The Health Meets Food program was created with the help of George Washington University to transform the way healthcare practitioners and their patients talk about food and health. About 50 medical schools and hospital-based internship programs in the United States utilize the program. Good outcomes in diet and lifestyle therapies have been identified among student nurses, nurse practitioners, patients, and practicing healthcare professionals. "The bold pie in the sky for the future of Culinary Medicine is that we will see an environment where every medical school and probably almost every hospital has a Culinary Medicine program. They have a teaching kitchen, and are teaching patients, community members, their staff, their faculty, their physicians, their nurses, teaching them how to cook great food," says Dr. Tim Harlan, MD, FACP  Part Two of 'Health Meets Food: Culinary Medicine. The Culinary Medicine Conference 2021 (June 4 – June 6, 2021) | Virtual Event The 2021 Culinary Medicine Conference – June 4-6, 2021 (7th Annual) – virtual this year – target audience is healthcare professionals and is targeted towards chefs and food services, lay public – open to anyone. The big theme this year is culture change. How, especially in health care, health professionals change the cultural environment that helps deliver culinary Medicine and nutrition type programing for patients? The keynote speaker is a New York Times best-selling author, Dr. Marion Nestle, who's going to talk about the food industry. The Saturday program includes another rock star, Dr. Robert Lustig, an expert, and a pediatric endocrinologist at the University of California, San Francisco. He has done a lot of work about the tremendous impact of sugar, especially high fructose corn syrup, on the obesity epidemic in America.  Moreover, there will be more professionals from the industry coming to speak about how they're changing the culture of their companies—how hospitals are changing their culture. But then there are also hands-on cooking classes and Skills Building Sessions that will all be done via Zoom.  I will be part of this conference on June 4, 2021. Along with Chef and Registered Dietician, Jodi Balis, we will co-moderate one of the skills-building sessions to optimally help patients who need different textures, say kids and/ or older adults who might need foods of different textures to help them eat.  "Health professionals need to know a lot about food to help their patients be their best." Dr. Tim Harlan, MD, FACP Additional Resources: Here are some resources if you're interested to learn more about Culinary Medicine.  Sign up for your newsletter at culinarymedicine.org (Zest newsletter) The Certified Culinary Medicine Specialist (CCMS) Certification Program Free Culinary Medicine CME Partner Sites for a local/ regional program from the culinarymedicine.org   About Dr. Timothy S. Harlan, MD, FACP: Timothy S. Harlan, MD, FACP, is a Professor of Medicine in the Division of General Internal Medicine and Director, GWU Culinary Medicine Program. Dr. Harlan practiced Internal Medicine in New Orleans. His love of food began as a teenager working in the restaurant business. Starting as a dishwasher, he worked his way up to managing his first restaurant by eighteen and owning his first restaurant at twenty-two. After operating Le Petit Café as a chef/owner, he closed the restaurant to return to school. Dr. Harlan originally intended to pursue a degree in hotel and restaurant management, but events led him toward Medicine and the decision to become a physician. In medical school, Dr. Harlan wrote “It's Heartly Fare”, a food manual for patients with cardiovascular disease. Since then, he has published numerous books focusing on translating evidence-based diet and nutrition information for the lay public. He is the publisher of the popular Web site DrGourmet.com where information from the Mediterranean diet literature is summarized in a practical way for the American kitchen. He served as Associate Dean for Clinical Services at Tulane University School of Medicine is the Executive Director of the Goldring Center for Culinary Medicine, the first of its kind teaching kitchen operated by a medical school. The center offers an innovative program teaching medical students about diet and lifestyle that bridges the gap between the basic sciences, clinical medicine, the community, and culinary education. Medical students work side-by-side in the kitchen with culinary students to teach each other and, most importantly, teach the community and patients how to return to their kitchens and transform their health. About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

May 11

29 min 28 sec

Welcome to This is Getting Old: Moving Towards an Age-Friendly World, I’m your host Melissa Batchelor, and today I’ll be talking about Five Things “The Father” Teaches Us About Alzheimer’s Disease A friend of mine recently reached out and asked me if I’d seen “The Father” yet with Anthony Hopkins and Olivia Coleman - Anthony Hopkins won the Oscar for Actor in a Leading Role. I have to say, I agree with this win. The movie plot is a daughter trying to provide care for her father who is living with progressive memory loss – so some form of dementia. Here are some things about what this film can teach us about providing care to a person living with Alzheimer’s disease or a related dementia and you can learn more by checking out my podcast “What are the Stages of Alzheimer’s Disease; Part I” where I talk about the common symptoms or difficulties you will see in the Early- and Middle-Stages of the disease.  #1: Misplacing or Hiding Valuable or Commonly Used Items  The father has several places around the house where he hides his watch and other valuable items. The caregivers know his hiding places and are able to redirect him to finding his watch that he accuses others of stealing. He’s suspicious and is fixated on his watch. You never know what someone will fixate on or why that object becomes so important to them, but rather than getting upset about it, you’re better off to address the underlying emotion being shared at the time – whether it anxiety or worry – rather than getting into a fight with them about how they are wrong.   #2: Mood swings when confronted with a mentally or socially challenging situation   The father has angry, explosive outbursts with his caregivers – in fact, he’s run 3 of them off in the film before the 4th one arrives. I’d recommend reviewing my podcast, Seven Tips for Managing Behaviors in Alzheimer’s Disease; How to Manage Anger and Aggression, and How to Manage Repetitive Behaviors. His behavior is driven by trying to control the situation and having trouble communicating with his caregivers. He is frustrated when words don’t work and you're experiencing brain failure, angry and aggressive non-verbal behavior to try to get his way.   #3: Loss of orientation to time, then place, and eventually person I think it was a great play to have this character fixated on his watch. He is obviously already disoriented to time and place, in that he believes he is in his own flat when he hasn’t lived there for years. Before the end of the film, he’s not sure who he is anymore and his caregiver has to tell him what his name is. By this point, he is institutionalized and is progressing in the disease.  The film doesn’t show his character with the functional losses that go with this disease – meaning, he can still walk and is getting around. In real life, the cognitive and functional losses will be in tandem – although they will occur at different rates of decline for different people.  #4: Personality and Behavioral Changes I’ve mentioned before that you may see delusions, hallucinations and suspiciousness in prior podcasts, but this film plays them out in a way that’s much easier to understand than these labels.  First let’s talk about his delusions – a delusion is a firmly held false belief. Throughout the movie, the father insists he is living in his own home, insists that nothing is wrong and that he can care for himself. Essentially, the underlying emotion here is feeling a loss of control and that deep rooted part of all of us that wants to be independent and autonomous. No matter what evidence is presented, he doesn’t change his belief, so his caregivers keep trying to have a logical conversation with an illogical person – due to brain failure. So as a caregiver, I don’t recommend frustrating yourself with presenting evidence over and over. Secondly, his hallucinations. These appear to be both visual and auditory hallucinations for the Father in this film. Hallucinations are hearing, seeing, smelling or feeling things that are not really there. For example, he hears a voice and follows it. #5: Personality and Sexuality I will tell you, that while this is an excellent depiction of what happens with brain failure, if you’ve seen one person with dementia, you’ve seen one person. So many aspects of this man’s personality shine through – the essence of who he was as a human being without the filter he may have had as a younger person. From idealizing his younger daughter, making cutting remarks to the older one, becoming very amorous with a caregiver who reminds him of someone he once knew…all of these things make up who he was as a person. So overall, I think the film is an accurate portrayal for this one man’s journey down the slippery slope of Alzheimer’s Disease. I have other thoughts about the caregiver interactions with him – but will save those for another podcast. Several interactions could have been handled differently to prevent and modulate his behavior….but that’s a beef for another day. Congratulations to Florian Zeller and Christopher Hampton for an amazing Screenplay and to Sir Anthony Hopkins on his Oscar nab! It was also great to see Olivia Williams again – still love her from Rushmore back in the day – and Olivia Coleman portrayed the very real emotional toll this disease takes on family caregivers and their lives. Leave me a comment below if you have other thoughts about this film’s portrayal of dementia – and thanks for tuning in! 

May 7

8 min 24 sec

Welcome to This is Getting Old: Moving Towards an Age-Friendly World, I’m your host Melissa Batchelor, and today I’ll be talking about Six Tips for Managing Behaviors in Alzheimer’s Disease.  In Alzheimer’s disease, a person may do things that are very distressing to you as a caregiver. These are often categorized as behavioral and emotional behaviors and may range from being irritable; having major mood swings of being angry or sad; or being agitated.  Alzheimer’s disease is in a nutshell, brain failure. When your brain fails, it means you can’t think clearly or interpret information from the world around you correctly. This can be frightening and confusing to the person living with the disease. These feelings of anxiety or being scared may cause the person to behave in ways that are challenging to you as a caregiver, but please understand that it’s not personal. The person living with Alzheimer’s disease is doing the best they can, and we need to adjust to them. Behaviors may include repetitive verbalizations – like saying “I want to go home” or “Help me! Help me!”. They may lash out in anger or resist care, like not wanting to take a shower or bath. They may accuse you of stealing from them or trying to poison them. These are just a few examples, but there are many other behaviors that you may see. The six tips I’m going to give you can serve as a problem-solving framework, because you’re going to have to be a detective and be reflective – as the person with the “big brain” – in order to manage these behaviors in an effective way.  So let’s get to it. Here are the Six Tips for Managing Behaviors in Alzheimer’s disease” #1: Restrict: This one is important if the behavior has the potential to harm the person living with dementia or others. Things that come to mind include access to firearms, managing their finances, or driving. Understand that restricting some things may be met with resistance by the person living with dementia, so involve other family or friends if they are. The main thing here is to maintain safety for everyone. #2: Reassess: Think back to when the person wasn’t demonstrating a particular behavior? Has a medication recently been changed? Anytime there’s a sudden change in behavior, work with your healthcare providers to see if a new underlying health condition, like a bladder infection or constipation, could be driving the behavior.  If a different approach was used, might that result in a different – less challenging – interaction?  If they have trouble with hearing or their vision, could they be misinterpreting what’s going on?  #3: Reconsider: Try to see the situation from the perspective of the person with dementia. Remember that Alzheimer’s disease causes a person to lose the ability to use and understand language, but they will pick up on your nonverbal behavior. If a person doesn’t understand what you are trying to do, they may become upset with you. Try using the Under Hand technique to provide a sensorimotor (or movement) cue when providing care, so you are doing with – instead of doing to – the person living with dementia.   #4: Rechannel: Look at what behavior the person is doing and see if you can channel it into something constructive, rather than destructive. Does it have meaning for that person? For example, I cared for a resident who had been a mail carrier for the post office his entire life. He spent most of his day trying to deliver mail to all of the residents in our nursing home. Rather than making him sit in a chair or medicating him, we gave him a mail bag with “letters” so he could “deliver the mail”.  #5: Reassure: When someone is upset, anxious or scared, they need reassurance – even with a normal brain! Reassure the person that they are safe, being taken care of, and that things are all right. Also, remember to reassure yourself. This is a HUGE job that is difficult and demanding. You are also doing the best you can, so give yourself a pat on the back for getting through one more challenge.  #6: Review: It takes two to tango, and two to tangle….if you experience a less than ideal interaction with your loved one, reflect on the event. Talk the situation over with a trusted friend or family member. Was there a trigger? At what point could you have intervened to minimize the conflict? Is there something you could have done differently? What could you try next time? And also be mindful that you may need more help – or more rest. Look into Adult Day Care options and Respite Care to allow an opportunity for you to get some rest. If you don’t take care of yourself, you can’t take care of anyone else. Unfortunately, there isn’t a rule book that says there’s one right way to respond to any behavior. I encourage you to be creative and engage other family members or friends to help to come up with ideas for how to best manage any behavior you find challenging. Multiple “big brains” are best for helping a person with a failing brain. You can also check out my podcast titled “How to Manage Repetitive Behaviors” to also learn about the C3P Problem-solving Framework. I also share more strategies for dealing with challenging behaviors.  Thank you for listening to this podcast and/ or watching this video. I hope these six tips are helpful to you in managing behaviors in Alzheimer’s disease.

May 7

7 min 46 sec

"The Age-Friendly Employers Program is the antidote to ageism. It gets people back into life, re-engaging, socializing, getting off the couch, not depressed, and contributing to society."-Tim Driver, Founder & CEO of Age-Friendly Ventures "The wisdom and experience of older people is a resource of inestimable worth. Recognizing and treasuring the contributions of older people is essential to the long-term flourishing of any society."  These words from Daisaku Ikeda, a peacebuilder and Buddhist philosopher, validate the role of older adults as part of a nation's workforce.  Employing and retaining older adults isn't "doing a good deed thing"; instead, it's more of "do what's expedient." Businesses, agencies, and companies struggle to recruit workers and keep those they have due to the 3.6% national unemployment rate. As this is combined with an increasingly aging population and changing demographics of young adults, "there would be no recourse but to consider the importance of older workers,"  This week on This Is Getting Old: Moving Towards an Age-Friendly World, we will be talking about Age-Friendly Employers with Tim Driver, Founder & CEO of Age-Friendly Ventures. Tim will shed some light on not only what an Age-Friendly Employer is, but also how to become one. Tune in to the episode, and together let's make the change towards a more age-friendly world.  Part One of 'Age-Friendly Employers'  What is an Age-Friendly Employer? The Certified Age Friendly Employer (CAFE) program of the Age-Friendly Foundation aims to recognize organizations dedicated to being the safest places to work for workers aged 50 and up and assist 50+ career seekers.  The typical retirement is unlikely to occur in the future due to demographic changes arising from increased life expectancy. Extended employment, progressively staggered unemployment, part-time or shortened hours, and other changed employment opportunities would be the norm, allowing workers to stay in the workforce longer. Age-friendly employers cater to the needs of aging employees and profit not only themselves but the whole economy.  Why Would A Business Want To Complete The Certified Age Friendly Employer (Café) Certification Program? The Age-Friendly Employer Certification program's purpose is to encourage work seekers in their 50s and 60s by recognizing employers who are dedicated to fairly evaluating them for suitable jobs, free of age stigma of ageism, which is one of older adult's primary concerns. Businesses should complete the Certified Age Friendly Employers Certification program to recognize that the organization realizes and understands that older adult's experience, maturity, dependability, and competitiveness are respected. "Age is, or can be, an impediment for older adults when they're seeking jobs." -Tim Driver, Founder & CEO of Age-Friendly Ventures. What Does An Age-Friendly Employer Certification Entail? The Foundation grants the recognition of Certified Age Friendly Employer following the satisfactory completion of the Certification assessment by the Age-Friendly Foundation personnel. Employers certified are recognized on the RetirementJobs.com website, related authorized sites, and promotional materials. Certified employers are often encouraged to use the recognition stamp on their business websites, on job listings on other online platforms, and in relevant branding content. Part Two of 'Age-Friendly Employers.' The Standards For Certification The Age-Friendly Foundation's analysis and review of recognized Age-Friendly employers' recruitment, employment, and human resources initiatives, processes, and services have resulted in a blueprint of validated best practice guidelines. The Certification assessment program is based on the twelve types of best practices standards. Twelve Categories for Best Practice Standards: General Commitment and Workforce Policies Organization Culture and Employee Relations Workforce Planning and Composition Employee Retention Candidate Recruiting Management Style and Practices Training and Development Job Content and Process Accommodations Work Schedules, Arrangements, and Time Off Compensation Programs Healthcare Benefits Savings and Retirement Benefits To find the Certification Evaluation Process/ Steps, visit https://www.agefriendlyfoundation.org/employers to learn more.  "Everybody who's in this Age-Friendly Employer Program is committed; because it's part of their diversity, equity, and inclusion plan." -Tim Driver, Founder & CEO of Age-Friendly Ventures Additional Resources:   The Age-Friendly Foundation is an organization working to fuel innovation that supports healthy, active, and productive aging for all through advocacy, education, and promoting collaboration among thought leaders in aging services.   On October 14, 2021, The Age-Friendly Foundation will celebrate 15 years of the Certified Age Friendly Employer (CAFÉ) Program with a unique convening of national policymakers, researchers, and senior representatives from certified employers.   In May 2022, a second global conference called "Revolutionize" will be held at the Boston Seaport Hotel to explore ways to revolutionize aging by fueling innovations that make aging easier.   Learn more about the inaugural conference here: View the photos from our inaugural Revolutionize Conference here. View presentations from Bright Horizons' Marc Bernicia, Lasell Village's Anne Doyle, 4Gen Ventures' Dominic Endicott, The Age-Friendly Foundation's Amanda Henson, Aging2.0 Co-founder Stephen Johnston, Global Alliance of International Longevity Centres' Dr. Alexandre Kalache, and 2Life Communities' Amy Schectman.   View a full write-up of Dr. Kalache's visit and the conference here.    About Tim Driver: Tim Driver has a successful track record starting and building digital businesses that make a social contribution. He's the founder and CEO of Age-Friendly Ventures, the parent organization of RetirementJobs.com, Mature Caregivers, and Age-Friendly Advisor. Tim was a Board Member and SVP at Salary.com held senior positions at AOL and Accenture, and co-chaired the Employment Committee for Massachusetts Governor Charlie Baker's Council to Address Aging. More notably, he was named an Influencer in Aging by PBS NextAvenue. About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

May 4

15 min 42 sec

Age-Friendly Ecosystems "It's a blessing to be an older adult." -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN For decades, advocates have called for communities, neighborhoods, and organizations like hospitals to become more "age-friendly." Although the idea of an age-friendly society has been promoted both locally and internationally, adoption remains more aspirational than an organized practice.  In this week's episode of This Is Getting Old, Dr. Terry Fulmer and Amy Berman walk us through an overview of what it means to have created an Age-Friendly Ecosystem.  Part One of 'The Age-friendly Ecosystems'. The John A. Hartford Foundation has been working with the Age-Friendly Foundation to convene leaders of these age-friendly movements. The goal is to help make the "age-friendly" moniker clear to all stakeholders in terms of what it means.  At the George Washington University’s Center for Aging, Health and Humanities, we have adapted the Age-Friendly Ecosystem to include Arts & Creativity.’ What Exactly Is an Age-friendly Ecosystem?  An Age-Friendly Ecosystem refers to the collective of all efforts to adapt society to meet older adults' needs. In simpler terms, Age-Friendly Ecosystems are the comprehensive, collectively built, and ever-expanding platform whose goal is to improve older adults' quality of life through enhanced, collective impact.  Moreover, understanding the Age-Friendly Ecosystem draws on the social-ecological model that acknowledges the connections and interplay between older adults and their environments or contexts. Proponents of the Age-friendly Ecosystem Movement The Age-Friendly Ecosystem is a movement to create age-friendly cities and communities started by the World Health Organization and carried forward by AARP (American Association of Retired Persons).  The John A. Hartford Foundation (JAHF) launched the Age-Friendly Health Systems movement with the Institute for Healthcare Improvement in 2017 to ensure the specific needs of older adults are met in health care. JAHF in 2018 then collaborated with the Trust for America's Health (TFAH) to involve public health agencies to expand the implementation of the age-friendly guidelines to the public health domain, acknowledging that these programs, notwithstanding their goals, have remained constrained and siloed. Many other organizations are advancing initiatives to make universities and businesses age-friendly.  The Goals and Objectives of Age-Friendly Ecosystems The goal of Age-Friendly Ecosystems has been to help make the "age-friendly" moniker clear to all stakeholders regarding what it means and how it should be adapted.   The work is leading to developing a common language and shared metrics so that anyone can recognize it and know what should be expected when we say "age-friendly." By working together across silos, different age-friendly initiatives can maximize their collective impact.  "An Age-Friendly Ecosystem refers to the collective efforts to adapt society to meet older adults' needs worldwide." -Terry Fulmer, PhD, RN, FAAN Guiding Principles and Frameworks of Age-friendly Ecosystems Each of the age-friendly initiatives has its guiding principles and frameworks. A big part of our effort is to help us understand those frameworks and what the shared characteristics are across them. The 4Ms Framework  An Age-Friendly Health System reliably delivers evidence-based care that reduces harm and focuses on What Matters most to older adults and their families. It is based on what we call the 4Ms Framework – essential elements of care that need to be addressed for all older adults – What Matters, Medication, Mentation, and Mobility. The 5Cs Framework The Age-Friendly Public Health Systems movement uses the 5Cs Framework:  Connecting and convening sectors and professions  Coordinating existing supports and services  Collecting data to assess community health status  Conducting, communicating, and disseminating research findings and best practices  Complementing and supplementing existing supports and services,  These frameworks are specific to the sector, clinical or public health in these examples but undergirding all of these frameworks are commonalities that lead us to the characteristics of an Age-Friendly Ecosystem. Part Two of 'The Age-friendly Ecosystems'. Characteristics of Age-friendly Ecosystems The convenings of leaders in the Age-Friendly Ecosystem, in addition to surveys of older adults, literature reviews, and expert interviews, have led to an understanding that several characteristics represent an age-friendly ecosystem. Understanding these characteristics helps us get to common language and metrics.  A forthcoming journal article will explain these characteristics and their definitions.  Age-Friendly Ecosystems: Current Standing in Terms of the Needed Common Language and Metrics  Since the fall of 2020, the Age-Friendly Foundation has been drafting a measurement taxonomy. They did that by identifying six outcome measurement domains that represent dimensions of age-friendliness. The domains are groups of similar outcomes, while the outcomes are explanatory concepts that can be inferred from measured or observed data. The Foundation is also looking at indicators or ways of measuring desired outcomes. They've looked at all the different frameworks outcomes and indicators – the Age-Friendly Health Systems, the Age-Friendly Public Health, WHO Age-Friendly Cities, AARP Livable Communities, Age-Friendly CAFÉ (Employers), and Age-Friendly Universities Principles— to supplement work in the health and public health frameworks.  Furthermore, the Foundation reviewed CDCs Healthy People 2030 indicators for Healthy Aging and Access to Care and the Association of State and Territorial Health Officials Policy Statement on Aging to expand and quantify outcomes related to health well-being. They've started with specific outcomes, such as Mobility, Walkability, Access to Jobs, and Labor Force Engagement. For each outcome, they identified indicators (or measures) recommended by IHI, CDC, WHO, and so on.  In some cases, they've added indicators where there were gaps based on a review of the literature. All of these are still in draft stages, and there is more to come. "Everyone has a role to play in eradicating ageism." -Terry Fulmer, PhD, RN, FAAN. How To Do Your Part In Building The Age-friendly Ecosystem? Everyone is encouraged to implement age-friendly programs, which will also  help us counter ageism and help all of us age with dignity and respect. In whatever sector you are in, reach out across to other partners. Start by checking out the blog on MelissaBPhD.com. You can find linked additional resources for age-friendly initiatives such as the Age-friendly Health Systems, Age-friendly Universities, and many more.   You can also join in the existing age-friendly initiatives, for example, the Age-Friendly Health Systems movement, by going to ihi.org/agefriendly. Or visit Trust for America's Health or our johnahartford.org website for more information on how to join the Age-Friendly Public Health Systems initiative, which has a new website: https://afphs.org/. "We've seen great success in this with public health working with aging services, working with health systems. This all connects to a crucial issue and call to action - everyone has a role in eradicating ageism, which is discrimination based on age. This means calling it out when you see and hear it. It requires you to make sure you aren't contributing to ageist perceptions of older adults." says Dr. Terry Fulmer, a nationally and internationally recognized leading expert in geriatrics.  “Older adults rightfully want and deserve dignity and respect.” Amy Berman, RN, LHD, FAAN About Terry Fulmer, PhD, RN, FAAN: Terry Fulmer, PhD, RN, FAAN, is the President of The John A. Hartford Foundation in New York City, a foundation dedicated to improving older adults' care. She serves as the chief strategist for the Foundation, and her vision for better care of older adults is catalyzing the Age-Friendly Health Systems social movement. Dr. Fulmer is an elected member of the National Academy of Medicine and recently served on the independent Coronavirus Commission for Safety and Quality in Nursing Homes to advise the Centers for Medicare and Medicaid Services. She completed a Brookdale National Fellowship, and she is the first nurse to have served on the American Geriatrics Society board. The first nurse to have served as President of the Gerontological Society of America, which awarded her the 2019 Donald P. Kent Award for exemplifying the highest standards for professional leadership in the field of aging. About Amy Berman, RN, LHD, FAAN: Amy Berman is a Senior Program Officer with The John A. Hartford Foundation. She works on the Foundation's development and dissemination of innovative, cost-effective care models that improve health outcomes for older adults. Among these efforts, Dr. Berman is responsible for the Foundation's work to advance Age-Friendly Health Systems, led by the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association.  She also leads many of the Foundation's efforts focused on Serious Illness and End of Life, including efforts to support Diane Meier's palliative care and the Center to Advance Palliative Care.    

Apr 27

17 min 16 sec

"See Me at the Smithsonian" “See Me at the Smithsonian is a program for adults with dementia and their care partners.” - Robin Lynne MarquisCommunity Outreach Coordinator "Beautiful, young people are accidents of nature, but beautiful old people are works of art."—Eleanor Roosevelt. Artists understood that an art piece helps both the artist and the viewers. Access Smithsonian is a catalyst for a consistent, integrated, and inclusive design that provides meaningful access to the Smithsonian Institution Museums and content for visitors with disabilities - of all ages. Today's episode of This Is Getting Old is part of the University Seminar Series   and the Age-Friendly Ecosystem work we're doing at the George Washington University Center for Aging, Health and Humanities, and today we are focusing on the role of Arts and Creativity in aging. I've invited two guests to share the See Me at the Smithsonian initiative - Robin Lynne Marquis, Community Outreach Coordinator for Access Smithsonian and the See Me Program; and Amy Castine, is Lead Educator for these programs. Join us for another age-friendly discussion on making life easier, happier, safer, and meaningful for older adults. Part One of 'See Me at the Smithsonian'. Access Smithsonian: What Is It All About? The Smithsonian, founded in 1991, is the central office for all of the 19 museums, National Zoo, and research centers for the Smithsonian units. On the internal museum-facing side, they advise museums on policies, practices, and procedures for the staff, including training and advising the exhibition teams on inclusive design.  Externally, they provide the best experience for visitors with disabilities. They also host internships for students with intellectual disabilities and engage with communities in the local area and nationwide to join or visit museums and meet their needs. Mission  Access Smithsonian is a catalyst for a consistent, integrated, and inclusive design that provides meaningful access to the Smithsonian Institution Museums and content for visitors with disabilities. Vision To be recognized for excellence as an Institutional and international resource for inclusive museum facilities, programs, and services. People with disabilities who visit will view the Smithsonian Institution as relevant, accessible, and valuable. Responsibilities Policy, Practices, and Procedures  Training and Education  Programming  Community Engagement  Inclusive Design  Access Services  Internships   “Morning at the Museum is a sensory-friendly program for families with children and adults with autism spectrum.” -Robin Lynne Marquis, Community Outreach Coordinator Inclusive Programs    Morning at the Museum   Morning at the Museum is a free, sensory-friendly service for families of children, teens, and young adults who have developmental disabilities, autism, sensory processing problems, or other cognitive deficiencies.   Project SEARCH Smithsonian Institution   Project SEARCH Smithsonian Institution is a ten-month internship program that encourages young adults with intellectual and cognitive disabilities to learn employable and marketable career skills.    User Expert Advisory Group   The User Expert Advisory Group of the Smithsonian Institution is a partnership between Access Smithsonian and the Institute for Human-Centered Design. User Experts are Persons with disabilities who have gained skills from their lived experience of coping with environmental issues attributable to a bodily, sensory, or cognitive functional disability.  At Smithsonian Institution museums, user experts assess the usability and functionality of physical spaces, museum exhibitions, public facilities, technology, and facilities. Besides, user experts educate Smithsonian employees, interns, and volunteers on inclusion, diversity, and usability.   See Me at the Smithsonian   See Me at the Smithsonian is a hands-on program for dementia patients and their caregivers. Pre-registered members (8-10 persons) discover some of the Smithsonian's most precious artifacts through small group interactions and multi-sensory exercises on scheduled weekdays.  See Me provides intellectual stimulation, socialization experiences, and the opportunity for loved ones to share quality time in a comfortable atmosphere.  Since May 2020, to adapt amid COVID, the program has been thoroughly transitioning to virtual See Me programs. Five museums have hosted virtual programs through Zoom to date  and intend to do so in the future.    National Portrait Gallery Smithsonian American Art Museum National Museum of Asian Art: Freer and Sackler National Museum of African American History and Culture National Museum of American History   Programs are conducted from 2:00 to 3:00 p.m. on the first and third Wednesdays of each month. On request, virtual programming for wider audiences in neighborhood locations is possible. “If you’re older and frail, you don't have much energy even physically and cognitively; going virtual does eliminate a lot of these hurdles.” Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN You can check on this website link: https://access.si.edu/program/see-me-smithsonian to learn more about the See Me at the Smithsonian Program. Part Two of 'See Me at the Smithsonian'. More About See Me at The Smithsonian The History of the Program  See me at the Smithsonian was an idea that began in 2016. An advisory committee was formed at that time, and folks who are experts in the field or have contact with people living with dementia formulated best practices and the ideas of how they wanted it to go forward.  Staff training began in September 2017, and the goal was to establish the accommodations and responsibilities as a museum and people working with the elder and disabled population. They had their pilot program with the National Portrait Gallery in October 2017, and from then on, it's been onward and upward. What The See Me at the Smithsonian Program is Today? The See Me at the Smithsonian program was able to expand to include the Smithsonian American Art Museum, the National Museum of African Art, and the National Museum of Asian Art: Freer and Sackler. From there, they start providing programming in a range of different subject matter areas so that folks can choose what is most interesting to them.  In the last two years, even before COVID happened, the brains behind the program recognized the need to expand the relationships to working within the community. These communities include senior residences, senior centers, villages, any social space where older adults are coming together and letting these folks know that they have a program for them. The goal is to prevent people from absent-mindedly wandering into a museum and letting them know that they could come to the free program.  Shifting to the Virtual Space   Due to the generous support of the Andrew W. Mellon Foundation and the Smithsonian's New York Regional Council, they're able to continue to expand even as they move into the virtual space through COVID. It's a meaningful, joyful experience for the organization to offer a better and broader range of topics for older adults and their caregivers to enjoy.  Since COVID, they've been offering programs to older adults within their actual residences or through their networks because they know that some of the most isolated people right now are in these places.  See Me en Español Launched in March    In March of this year, they started the program in Spanish—that's been a big dream of the organization for many years now. Carmen Pastore, the lead educator, leads the team, and they're now providing the program in Spanish.  “There's an intellectual and creative stimulation that comes with the See Me at the Smithsonian program.” -Amy Castine, Lead Educator  What Will You Experience at The See Me at the Smithsonian Program? The experience was much like what anyone would experience when they came into a museum where they would meet at a central location and then move toward art pieces. The most significant difference for older adults is that we're slowing down and looking at fewer objects. Below are some of the examples of the activities you’ll experience at the See Me at the Smithsonian Program.   Close Looking   "A typical tour would be 8-10 objects in an hour. But for our older adults, we recognize that processing times are different, and the ability to move from one place to another is a little different.  We want to make sure that the program meets their needs exactly as they are. We would look at two or maybe three objects in the gallery and spend our time doing "close looking."  Instead of just glancing at an object, we would sit and take a deep breath and relax for a moment and spend a minute just looking, without speaking, without any interpretation, and then move to ask, "What do you see in the object?", "What is the mood of this piece?, What is it bringing up for you?" These are meaning-making that we participate in when we look at the objects," says Lead Educator Amy Castine.     Collaboration with Arts for the Aging   The organization also partnered with Arts for the Aging, a local Washington, D.C. organization. One of the things that they add to the programing is participating with artists; they may be visual artists, musicians, poets, or storytellers.  In the process of looking at an artwork, say, looking at a screen at Asian Art of the Tales of Genji, a storyteller will tell a little story that's not just about the object itself but take the ideas that the participants generate and weave those into a tale of their own. If you're interested in reaching out to Arts for the Aging, you can connect with them at: Arts for the Aging Twitter: @artsfortheaging or  Arts for the Aging Facebook https://www.facebook.com/ArtsfortheAging/   Hands-on Creative Stimulation Activities   One instance shared by Amy Castine is looking at the Big Egg at the National Museum of African-American History and Culture. Working with a teaching artist, the materials that older adults and their caregivers happen to have on hand, whether that's wrapping paper or tissue paper or pens of different colors, highlighters, are used to create their big egg. So there's intellectual stimulation that comes with this, but there's also creative stimulation. How To Connect With Access Smithsonian?  Connect with educators or learn more about Access Smithsonian by following this link to their  You can email them at access@si.org and they will route your email to the right place! 💻 Website: https://access.si.edu/ Access Smithsonian account at Access Office Twitter: @access_si or @smithsonian The Smithsonian Facebook page: https://www.facebook.com/Smithsonian The Smithsonian Instagram Account:  https://www.instagram.com/smithsonian/ The smithsonian Youtube Channels:  https://www.youtube.com/channel/UCcBeQ2q6YyOpOaUREG-Z3pg https://www.youtube.com/channel/UCi1Yd0I01shhy-uknz-SQBQ https://www.youtube.com/channel/UC_66nY81jHx8OsvfjhFydZw https://www.youtube.com/channel/UCZW0jH_nivSuvSmFHppURyg https://www.youtube.com/channel/UCKgRzail9_28oDRHbMKLPRg https://www.youtube.com/channel/UCYm9MWccmz9n2yyMx9vRrXg About Robin Lynne Marquis, Community Outreach Coordinator:   Robin Lynne Marquis has over a decade of experience leading initiatives, programming, and community collaborations with institutions of all sizes and people of all ages. She currently serves as the Community Outreach Coordinator for See Me at the Smithsonian and as the Accessibility Coordinator for The Peale Center. As an artist with a disability, Marquis is part of a national network of thought leaders shaping the conversation about accessibility in the arts while contributing to local efforts that combine creativity, education, and activism to achieve positive social change.  About Amy Castine, Lead Educator: Amy Castine is an art historian and visual artist. She engages with people living with dementia and their care partners using visual arts and historical objects to facilitate conversation and encourage cognitive stimulation. As the lead educator for the See Me at the Smithsonian program since 2017, Amy collaborates with the staff of several Smithsonian museums to coordinate, plan, and deliver programs for individuals with dementia who are aging in place in the greater Washington DC area.     She has also developed and implemented a training program for museum docents interested in facilitating dementia-friendly programs. Amy contributes to the Just Us program at the National Gallery of Art in Washington DC, focusing on individuals with dementia and their care partners. In her free time, Amy enjoys painting, creating one-of-a-kind beaded jewelry pieces, and teaching various art techniques to students of all ages.  About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN:   I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Apr 20

16 min 24 sec

Age-Friendly Universities  Colleges and universities are preparing future leaders, who will interact with older adults; yet we don't give them the essential skill set for interacting with that population and how to tailor to their needs  -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN ______________________________________________ Higher education in the United States has historically centered on delivering programs for younger people. By 2025, students aged 25 years old and above will make up 42% of the United States' college and university student populations. Evidence has established that universities can not only significantly impact older adults' later-life advancement, but content on aging is critical in higher education to prepare younger generations for the workforce. Age-Friendly Universities are gaining traction. There are currently over 70 state colleges and universities worldwide that are members of the Age-Friendly University Global Network with schools in Australia, Canada, Asia, Europe, and the United States.  In today's episode, we will be talking about Age-Friendly Universities. I am joined by Dr. Joann Montepare, Professor of Psychology from Lasell University and the Convener of the AFU Research Interest Group with the Gerontological Society of America. Part One of 'Age-Friendly Universities ' The Administration on Aging of the Department of Health and Human Services has reported that the United State's population of older adults is expected to more than double by 2060.  7 out of 10 Americans who will shortly "retire" claim they intend to work after retirement. Many older adults will have not just one, but up to three, occupations during their lives.  Consequently, the current parameters in education, employment, industrialization, healthcare, and other areas will change globally. The overarching goal of the Age-Friendly Universities Initiative, more than just looking at older adults' welfare, is to pave the way for these imminent transitions.  "Age-Friendly Universities appreciate the need to provide younger students with education about aging." -Joann M. Montepare, PhD  What Does It Mean To Be An Age-Friendly University? "Age-Friendly University" is a distinction that acknowledges a tradition of active learning and age-inclusiveness in higher education systems and activities.  Age-Friendly Universities are committed to: Provide educational and research resources and innovations that cater to the expectations and aspirations of an aging population. Acknowledge aging and demographic shift among students, staff, and workers in the field of education. Increasing access for age-diverse learners for personal and professional development. Broaden the access to aging education. Decreasing age segregation and enhancing intergenerational opportunities, especially for older adults.  Part Two of 'Age-Friendly Universities ' The Pillars And Principles of Age-Friendly Universities In an effort to embrace intergenerational education in college and universities, Six Pillars of Age-Friendly Universities and the Ten Age-Friendly Principles were established to create Age-Friendly Universities. The Six Age-friendly Universities Pillars of Activity (Core Areas of Higher Education)  To extend age-friendly awareness and expertise, universities that support age diversity and age-friendly initiatives should be anchored on these six pillars of activity in higher education: Teaching & Learning Lifelong Learning Research & Innovation Intergenerational Learning Encore Careers & Enterprise Civic Engagement   "The ten principles of Age-Friendly Universities are a framework to help universities to become more age-friendly." -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN  The Ten Age-Friendly Universities Principles The 10 Age-Friendly Universities principles include an idealistic and systematic model that enables higher education organizations to commit more attention to aging and education. Institutions from all around the world are welcome to embrace the following 10 Age-Friendly Universities principles: To encourage the participation of older adults in all the university's core activities, including educational and research programs. To promote personal and career development in the second half of life and support those who wish to pursue second careers. To recognize the range of educational needs of older adults (from early school-leavers to those who wish to pursue master's - or doctoral-level qualifications. To promote intergenerational learning to facilitate the reciprocal sharing of expertise between learners of all ages. To widen access to online educational opportunities for older adults to ensure a diversity of routes to participation. To ensure that the university's research agenda is informed by an aging society's needs and to promote public discourse on how higher education can better respond to the varied interests and needs of older adults. To increase students' understanding of the longevity dividend and the increasing complexity and richness that aging brings to our society. To enhance access for older adults to the university's range of health and wellness programs and its arts and cultural activities. To engage actively with the university's retired community. To ensure regular dialogue with organizations representing the interests of the aging population. How To Become an Age-friendly University Partner? Join the Age-Friendly University Network to build more age-friendly institutions of higher education. Send a confirmation letter of your institution's endorsement to Christine O'Kelly, Age-Friendly University Global Network Coordinator at DCU (christine.okelly@dcu.ie, website: www.dcu.ie/agefriendly) and AGHE (aghe@aghe.org). Include the AFU contact(s) at your institution, a link to your institution's website, and a copy of your institutional logo to be used on the DCU AFU webpages. It is also helpful to state what you wish to achieve by participating in the AFU initiative. About c : Joann M. Montepare is Professor of Psychology and Director of the RoseMary B. Fuss Center for Research on Aging and Intergenerational Studies at Lasell University. She earned her PhD in lifespan social-developmental psychology from Brandeis University and conducts research exploring social and personal perceptions of age. An advocate of intergenerational teaching and learning, she has developed innovative educational programs such as Talk of Ages which bring older and younger learners together across the curriculum and provide resources for educators to integrate intergenerational exchange and aging content in their classrooms. A champion of the Age-Friendly University (AFU) initiative, she has been involved in various efforts to advance age inclusivity in higher education and the AFU global network. She is the convener of the GSA AFU interest group, AGHE (Vice) Chair, and President (elect) of APA’s Division 20 (Adult Development and Aging). An active member of the Boston aging network, she is past president of the Massachusetts Gerontology Association (MGA) and serves on boards and councils of diverse community organizations. Her most recent collaboration is the RRF-funded study with UMass Boston colleagues, Taking the Pulse of Age-Friendliness in Higher Education in the US Today. She is an AGHE, GSA, APA, and SESP Fellow.   About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN:   I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and joined the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.   To learn more, please visit:   Dublin City University – Global Network – Toolkits (DCU Age-Friendly) – new website is coming DCU AFU   https://www.dcu.ie/agefriendly GSA AGHE AFU https://www.geron.org/programs-services/education-center/age-friendly-university-afu-global-network Tools for Advancing Age Inclusivity in Higher Education The Lasell university Fuss Center at https://www.lasell.edu/fusscenter and the Lasell University Fuss Center, Talk of Ages at https://www.lasell.edu/talkofage GSA Newsletter Advancing Age Inclusivity in Higher Education. Comments and suggestions are welcomed from readers. Please send correspondence or subscription requests to ageinclusive@geron.org.

Apr 13

38 min 48 sec

Rethinking Nursing Homes and Care of Older Adults "Communities should create solutions that aren't just involving geriatricians of the world or the geriatric nurses and social workers. It's going to take everybody pulling together."  -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN ____________________________________________________________________ "Grow old along with me. The best is yet to be. The last of life for which the first was made." In 1864, as Robert Browning wrote those words, growing old was not regarded the same as it is today. Before nursing homes and assisted living facilities, older adults aged at home alongside their families. Today, most people still age in their communities; but for the aging population that becomes frail, they may need the support from these long-term care institutions. However, the current nursing homes and care parameters for older adults often stigmatize aging and overlooked what people want when they get older. To counter this, we need a shift in mindset, one that sees older adults as persons with diverse needs, dreams, and aspirations about their future rather than just patients in need of care. In this episode of This Is Getting Old, join Dr. Stuart Butler and me in rethinking nursing homes and care for older adults. Part One of 'Rethinking Nursing Homes and Care of Older Adults'. The Convergence Report on Rethinking Care for Older Adults    History and Background   The Convergence Report on Rethinking Care for Older Adults is released at the end of November 2020. It was supported by the John A. Hartford Foundation, which funds a lot of work in the long-term care area on aging.  The convergence conversation aimed to bring together about 50 people from very different backgrounds and different points of view to see if there are common ground areas. They were asked to brainstorm about the issues impacting today’s nursing homes, what's going on there, and what could be done differently. They were also asked to explore other ways that people can age outside of nursing homes.  A crucial part of the conversation revolved around the workforce and the caregiving field, the workforce's nature and how to think about it differently in the future, and the financing of aging in American care and nursing homes.   The Findings Of The Convergence Report On Rethinking Care For Older Adults   The resulting main areas revolved around living outside nursing homes, the payment system, and the caregiving workforce.  Today's nursing home system is increasingly out of date and the product of the payment system. The majority  of older adults need not stay in nursing homes. There are ways of enabling them to live more successfully in their own homes and their communities. People and institutions can help older adults stay in their own homes, avoid isolation, and be safer. Today, the caregiving workforce is predominantly low-paid, very heavily immigrant—It's a low-skilled, low-paid workforce.  "Only 5% of people over 65 ever end up in a nursing home, but they account for 50% of the state's budget." -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN  Reimaging Nursing Homes and Other Care Institutions Alternative Business Models & Payment Systems The current payment system for long-term care forces many older adults to go into a care setting, which may not be the right one for them. It may not be ideal and indeed may not make them happy and may cut them off from their family.  If a family  asks, 'What's the next best thing for mom?' The first response right now will be, 'We need to talk about your finances to figure that answer out.'  Exploring The Financing And Workforce Elements   Medicare + Medicare   There's a lot of interest in revamping the rules and the regulations associated with, particularly Medicare and Medicaid, as to what they would cover. Medicare and Medicaid alternative services should be more open to covering home- and community-based services. However, exploring these options has the potential to  save government spending on Medicaid and Medicare in the long term.    Role Of Private Health Insurance   One possible solution for people who do have some savings but are afraid of them being exhausted and then ending up on Medicaid, is providing a so-called “catastrophic backup” to long-term care insurance. The idea is to have legislation that would set this up to stabilize the long-term care insurance industry to make it more viable in the future. When this happens, then far fewer people would fall into this trap of being unable to pay.    Role Of Long-term Care Insurance   The long-term care insurance industry has declined very sharply in the last several years, in part because younger people don't think of having long-term care insurance. The other thing is people are living longer, and they live longer with sometimes costly illnesses that impact their ability to be independent. So long-term care insurers face these enormous potential costs; so this approach is not working. Part Two of 'Rethinking Nursing Homes and Care of Older Adults'. Expanding the range of older adult-friendly housing and communities 95% of older adults do stay and age in their own homes. Below are some ideas to help people age at home.   Design and Collaboration   Architects involved in the convergence conversation think about how to design housing that is safer and more open. These perspectives include looking at group housing, in various forms, and thinking about how multifamily units can be designed so that an older person can have that privacy, and so on.  But more than these essential design features, we also look at how to build social capital  that helps an older adult live in their own home and community, but not be isolated and cut-off from the rest of society.   Role of Technology   There are also a lot of improvements in technology. For instance, monitoring older adults, a doctor, or a nurse in the area can know if that person is getting unsafe in some way like a potential fall, etc. Technology connects health care providers and older adults so that their needs can be addressed.  “We’re on the cusp of thinking differently about nursing homes in the future.” -Stuart M. Butler, Senior Fellow, Economics Studies Thinking About The Caregiving Workforce Differently Workforce Issues: Other Resources to Learn More   LeadingAge Report: Making Care Work Pay   LeadingAge released a new report, Making Care Work Pay. The report highlights health care professionals as an essential part of the United States' healthcare infrastructure and accounts for a significant portion of its workforce. Every day, nearly 3.5 million direct care staff operate in residential care centers and private homes to offer care for some of society's most needy members—the elderly, the disadvantaged, and the mentally impaired. Given the value of health care staff to our country's health and economy, health care professionals continue to be undervalued and underpaid. Poor wages and stressful working conditions exacerbate persistent workforce problems. As a consequence, efficiency and care delivery aren't as good as they should or could be.    Milken Institute Center for the Future of Aging Report   (Recommendations to Build a Dementia-Capable Workforce and System amid    COVID-19) The recommendation aims to endorse the GWEP program's recent sanction, which authorizes almost $39 million in funding to expand geriatric expertise across the healthcare system over five years. Such action is anchored because, despite the reality that the number of individuals living with Alzheimer's disease is predicted to increase by 2050, a lack of geriatricians, nurses, and social workers with advanced expertise in geriatrics and complex dementia treatment is on the horizon.·          Mathematica Report COVID-19 Intensifies Nursing Home Workforce Issues (Full report available as a downloadable PDF) Mathematica Report studies show that workforce shortages and turnover also strained nursing homes during the pandemic's climax. Many nurses and licensed nursing assistants have recently quit the industry due to low wages, inadequate working conditions, and the high risk of COVID-19 contamination at a period when their skills and experience are in high demand. Thinking About The Healthcare Workforce In Different Ways   Improving Training   Improve training for healthcare providers. At the moment, there's minimal federal training and federal requirements on states that need to be expanded enormously to raise the skill level. Want to know how your state is doing in terms of long-term care support and services (LTSS)? Find out from the AARP Foundation Long-Term Services and Supports State Scorecard 2020 Edition  About Stuart M. Butler, Senior Fellow: Stuart Butler is a Senior Fellow at Brookings. Before Brookings, he spent 35 years at The Heritage Foundation as the Director for the Center of Policy Innovation and, earlier, as VP of Domestic and Economic Policy. He has recently played a prominent role in the debate over health care reform and addressing social determinants of health. Butler is a member of the Health Affairs editorial board, an advisory board member of the National Academy of Medicine's Culture of Health Program, and the Board President for Mary's Center, a group of community health clinics.   About The Brookings Institution: The Brookings Institution is a nonprofit public policy organization based in Washington, DC, whose mission is to conduct in-depth research that leads to new ideas for solving problems facing society at the local and national level and globally. About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN]: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and joined the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Apr 6

44 min 50 sec

Integrative Medicine and Healthy Aging "People can stay healthy when their head, heart, and spirit are aligned."-Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN Polypharmacy is a significant concern in geriatric treatment, presenting a chance of adverse effects and medication reactions. Although older adults under the age of 60 take 2–3 prescription medicines every day, those above 80 consume over 4–5 prescriptions per day. With that, many older adults in the United States are shifting to integrative medicine to boost their Quality of Life (QOL) significantly. The shift is a result of health issues and as a support for their beliefs and underlying theories about health and lifestyle. However, despite its increasing popularity, integrative medicine's impact on an older adult's quality of life and preventive medicine is too well understood. To fill in the gap, I am joined today by two guests, Dr. Leigh Frame and Dr. Mikhail Kogan, both from the George Washington University's Center for Integrative Medicine. We will be having meaningful discussions about The role of Integrative Medicine in Healthy Aging. Part One of 'Integrative Medicine and Healthy Aging.' What is Integrative Medicine? Integrative medicine is a pyramid of treatment that starts with non-invasive, non-surgical, non-pharmacological methods, especially for chronic conditions that often don't have a curative pharmacologic approach.  Moreover, integrative medicine focuses on the whole person and their entire lifestyle. It looks at all aspects of their life, support system, mind, body, and soul. It's an all-inclusive systems approach to health and wellness that uses any evidence-based therapeutic available. “Among people over 65 years old, prescriptions are the third cause of death, killing approximately a quarter of millions of Americans every year.”  -Mikhail Kogan, MD, AM How is Integrative Medicine Similar or Different to Traditional Primary Care? Integrative medicine is known in other terms as alternative medicine, traditional medicine, complementary and integrative medicine (CAM), or non-mainstream medicine. Furthermore, as described by the National Institutes of Health, integrative medicine is a non-mainstream treatment used outside traditional primary care. As a result, integrative medicine is by far uncommon in the United States.  On the other hand, traditional primary care is what the majority of people are familiar with. Primary care has been described in a variety of ways. Basically, it includes healthcare professionals' treatment— Primary care areas of expertise include general internal medicine,  family medicine, general pediatrics, and obstetrics and gynecology.  Moreover, its scope extends to health care activities that characterize the range of primary care, including treating or relieving common diseases and disabilities. Traditional primary care can also be defined as a level of treatment or  program that integrates secondary care (provided by community hospitals) and tertiary care  (by medical centers ) Examples of integrative medicine approaches are;  Acupuncture Hypnotherapy Massage Meditation Psychotherapy Holistic Primary Care Reiki Yoga Part Two of 'Integrative Medicine and Healthy Aging.' The Role of Integrative Medicine in Aging Well There is this famous thing in geriatrics, "Don't look for zebras. Look for cows that look like zebras" because the common conditions that are often present in older age are extremely unusual, but they're still prevalent.  So if you don't think in that framework and if you don't ask, "Could this be that it just looks like this kind of zebra, but it's not actually a zebra?" It means that specific to primary care and to integrative, most healthcare professionals are looking for zebras because they're kind of cool. They always look for some more fascinating diagnosis—but in geriatrics, that's not the case.  “Look at the bigger picture rather than just the symptoms.”  -Leigh A. Frame, PhD, MHS    To understand some of the older age's illnesses and chronicity, you need to understand how it occurs in the younger age. Most of the diseases can be traced to middle age or even younger age. It is understanding how to advocate for specific steps and care and, more importantly, what questions to ask when somebody comes to you regarding their chronicity. Furthermore, with integrative medicine, the physician role stops being a physician role. You're becoming a mirror for a patient, and you're suddenly becoming a reflection to help them to see what they're doing right and wrong, and then select the choices to move forward. A lot of what's done in integrative medicine is not rocket science: eating well, sleeping well, exercising,  staying positive, and staying balanced in terms of the nervous system - it's not all that complicated, but achieving these can be quite challenging at times. About Mikhail (Misha) Kogan, MD, ABIOM, RCST Dr. Kogan received his medical degree from Drexel University, College of Medicine.  He completed the Social Internal Medicine Resident program at Montefiore, Albert Einstein School of Medicine and Geriatric Fellowship at George Washington University.  Currently he serves as medical director of the GW Center for Integrative Medicine, associate stant professor of medicine in division of Geriatrics and Palliative Care, associate director of the Geriatrics Fellowship Program and director of Integrative Medicine Track program at the George Washington University School of Medicine.    Dr. Kogan is founder and executive director of AIM Health Institute, a 501(c)(3) non-profit organization in the Washington, D.C. metropolitan area that provides integrative medicine services to low-income and terminally ill patients regardless of their ability to pay.  About Leigh A. Frame, PhD, MHS Dr. Leigh Frame brings nutrition and immunity together through clinical, translational research. Dr. Frame’s T-shaped expertise in health, wellness, science, and medicine were developed through her wide-ranging experience in biomedical research (from wet bench to clinical research) and overseeing research and education programs. Dr. Frame is working to build a GW Integrative Medicine research program while directing the graduate education programs and the Office of Integrative Medicine and Health. Her interests include the role of the microbiome and nutrition in health, the consequences of malnutrition in obesity, vitamin D as an immune modulatory hormone, research ethics, and social media. While working at the Johns Hopkins Center for Bariatric Surgery, Dr. Frame earned her PhD in Human Nutrition from the Johns Hopkins Bloomberg School of Public Health and also received a Master of Health Science in Molecular Microbiology and Immunology from the same school. About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Mar 23

35 min 58 sec

How to Manage Anger and Aggression in Alzheimer's Disease? “When older adults are acting badly, that is a sign of an unmet need.”-Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN Older adults with Alzheimer's disease can get angry or be aggressive.  These types of behaviors, when associated with Alzheimer's disease, can be a challenge for care providers and family members alike. These behaviors should not be overlooked and should be taken into consideration of the context in which the behaviors occur to try to find a solution.   Join me for this episode of This Is Getting Old: Moving Towards an Age-Friendly World, where we'll talk about How To Manage Anger and Aggression in Alzheimer's Disease. Part One of 'How To Manage Anger and Aggression in Alzheimer's Disease.' Anger and aggression generally happen in response to some underlying trigger, resulting in the behavior(s) observed. Below are some of the underlying causes of anger and aggression for an older adult living with Alzheimer's disease and the best ways to respond as a caregiver.  Understanding The Underlying Cause(s) Or Trigger Possible Cause 1: Brain Changes As caregivers or family members, you need to understand what cognitive abilities remain intact versus what deteriorates. Alzheimer's disease is essentially “brain failure” - meaning memory ability is lost over time, and thinking and problem-solving become much more difficult. At a certain point, the person also loses the ability to use and understand language. However, one part of the brain that remains intact is the basic responses of Fight, Fright, or Flight. The Fight, Flight or Fright response may be what’s coming out as angry or aggressive behavior in the person with Alzhiemer’s disease, so we need to be mindful of this when interacting with a person. To make sure that they hear us and see us, before we touch them. Possible Cause 2: A General Health Problem or Physical Discomfort Another trigger for angry and/or aggressive behaviors are a general health problem or physical discomfort. You need to understand that when a person with Alzheimer's disease is experiencing pain or discomfort, they aren't going to be able to tell you what's hurting. They may hurt in their elbow or their hip, but they can't tell you exactly where they're hurting because they can’t localize pain (what this means is that when they feel pain all over - rather than in one specific spot). To figure out if or where they are hurting, you will have to look at nonverbal behavior, such as facial grimaces or holding a specific part of their body. Look for any nonverbal behavior as the way the person will communicate with you - rather than just straight out telling you what's wrong when they can no longer use or understand words.  Possible Cause 3: Environmental Factors The environment does have an impact on someone with Alzheimer's disease. If your home is generally quiet or you live by yourself when you have a little bit of cognitive impairment, if the whole family shows up and there are twenty-five people in the room, that is a totally different level of activity. The sudden change of environmental noise may be too much stimulation and this  can create anxiety, which might drive angry and/ or aggressive behavior(s).  Possible Cause 4: Poor Communication When a person living with Alzheimer's disease loses the ability to use and understand words, their only option is to use behavior to communicate with you. When you see someone acting badly, that is usually a sign of an “unmet need” - so trying to figure out what they may need will be the better strategy for managing the behavior. Part Two of 'How To Manage Anger and Aggression in Alzheimer's Disease.' Best Ways to Respond?  Response 1: Safety First If you're dealing with someone that's very angry and they are being very aggressive, the first thing to do is to make sure to maintain their safety.  Once you know they are safe, it would also be best if you back off and give them space to calm down. You may need to remove yourself from the room if the anger or aggression is directed towards you. Give them the time and the space they need to calm themselves down in a safe place. Response 2: Become A Detective After making sure the person is safe, the next best response is to become a detective. I usually teach what I call the 3CP Model. The 3C’s are: Change the person, Change the people, or Change the place. This is a simple way to think through identifying behavioral triggers and preventing or resolving problematic behaviors. CHANGE THE PERSON When thinking about something that may need to Change the Person - this means the Person living with Alzheimer’s disease. As caregivers, when we look at the person, we need to think about what their behavior is trying to tell us. There is some “unmet need” driving the behavior: Are they hot? Are they cold? Are they hungry? Are they tired? Or are they in pain? Starting with seeing if there’s anything that needs to be addressed for the Person is the first place to start.  CHANGE THE PEOPLE The second level to think through that may need to Change is the People -  this means us as caregivers. Think through if there may have been something that you did when interacting with the person that accidentally sets the behavior off.  Always give people warnings that you're coming, by making sure that they see you and hear you first. Startling someone can  sometimes set off aggressive behaviors.  CHANGE THE PLACE The third thing to consider is Change the Place - this means the environment. Is there too much noise? Do you need to move the patient into a different environment with less distractions? Too much background activity can sometimes cause stress, which can trigger anger and aggressive behavior. Response 3: Don't Push Your Agenda. Sometimes as caregivers or staff members, we have things that we need to get done - such as helping the person get dressed or get a bath - and we're very focused on getting these things done within a certain time frame. In the well-meaning spirit of helping the person with Alzheimer’s disease, we try to push our agenda on the person.  During our time frame, the person we are helping may or may not feel like doing the things.   When you first sense a change in behavior from cooperation to resistance, remember that resistance is met with resistance. If the person gets agitated and you get agitated back, it becomes a tug of war between the two of you - which doesn’t help either one of you.  When this happens, as the people with the “big brain”, you need to back off and wait for a different time. If the person you’re trying to help becomes aggressive,  try to shift the focus to another activity - and come back to whatever it was that you're trying to get them to do.   Response 4: Reflect and Regroup If you get into the “resistance is met with resistance” dynamic, take time to think through that interaction, reflect on how the situation could have been handled differently, and regroup. There is a way to pick up on someone's nonverbal cues earlier, as soon as they  start to become agitated in order to prevent it from getting into a full-blown fight.  And if you’ve tried several times and you can't figure out what's going on, ask another person, someone you trust, to come in and watch. Let someone else observe the  interaction(s)  can help you see if there's something that you may be missing - doing this can also be helpful.  Furthermore, getting into a support group of finding family/ friends you can share your experience with can also help. A person living with Alzheimer’s disease is doing the best they can, so try not to take it personally.  About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN]: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Mar 9

9 min 28 sec

The 5Cs Framework of the Age-Friendly Public Health Systems                              "TFAH wanted to provide an opportunity to explore and expand public health's role in aging. Our goal is that state and local public health departments across the country become age-friendly public health systems. This means they recognize aging as a core public health issue and then leverage all their skills and capacity to dive in and improve older adults' health and well-being." -Megan Wolfe, JD (03:08-03:35) Americans are living longer and more productive lives than ever before and we’re going to see a rise in both the number and proportion of older adults – to nearly a quarter of the population by 2060. That’s 98 million people…and means if you were born in 1995 or earlier, we are talking about you and what you’re going to need as you get older. This will not only be the largest number of older adults in our history, but they will also be the most racially and ethnically diverse older population we’ve ever seen.  In line with that, in today's episode of This Is Getting Old, we will be talking about Age-Friendly Public Health Systems as part of our Age-Friendly Ecosystem Series.  In five previous podcasts, we talked about the history of the Age-Friendly Health Systems initiative and the 4M's. Today I am joined by Megan Wolfe, who is with Trust for America's Health – a non-partisan public health policy, research, and advocacy organization that envisions a nation that values health and well-being for all. The good news in talking about an Age-Friendly Public Health system today is that the COVID pandemic has illustrated the critical role public health plays in our daily lives, both as American and global citizens. Public health’s mission to improve the health and safety of our nation has not been in the forefront for as long as it has during the pandemic.  Every public health department should be age-friendly - and while we have a lot of work to do, a lot of great work is already being done and today’s episode highlights that. Part One of 'The Age-Friendly Public Health Systems.' America's public health sector has very few specialized programs that emphasize older adults' safety and well-being. It has always been an afterthought as public health struggled with the concerns of older people.   Building and embracing Age-Friendly Public Health Systems and communities is an important way of promoting public health, vitality, and aging. Thus, research, experience, and policy on aging projects began to transform this promising concept into concrete actions that could be  encouraged and supported by the government. These efforts answer concerns about the forms in which societies can impact healthier aging, age-friendly neighborhood programs, and outlines historical and future actions to promote community improvement mechanisms on behalf of our increasingly aging population. Two questions drove the conversation when thinking about Age-Friendly Public Health Systems: Does public health have a role to play in aging? Would the aging services sector welcome public health being engaged in this work? "To become age-friendly is to understand the principles for age-friendly initiatives, but then taking principles and determining how to tailor it to where we live; to the needs of that particular aging population." Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN The Importance of Creating an Age-Friendly Public Health Initiative  The reasons that public health hasn’t included older adults and aging has been two-fold: Many of the policies designed to support older adults, like Medicare, Medicaid, and the Older American's Act, did not explicitly include a role for public health. There has always been a lack of funding for general public health agencies for dedicated initiatives for those 65 years and older Public health has contributed to Americans' longevity, so it only made sense to explore and expand its role in healthy aging, in partnership with the aging services sector that already does so much to serve this population. The Birth of Age-Friendly Public Health Systems Initiative  In place of this state of public health, in 2017, a group of leaders came together to develop a public health framework to support older adults' health and well-being. A year later, under the leadership of TFAH, the John A. Hartford Foundation, the Florida Departments of Health and Elder Affairs, the AFPHS initiative started as a pilot in Florida and included. 37 of the states’ 67 county health departments. The Florida pilot demonstrated the value of  aligning and coordinating approaches for older adults to identify and provide  needed programs and services. Thus, AFPHS offers a framework that allows priorities to be established based on geographic region/ communities. It gives public health practitioners a place to start. Part Two of 'The Age-Friendly Public Health Systems.' What's the Framework For an Age-Friendly Public Health System All about? The Framework for an Age-Friendly Public Health System includes five key potential roles for public health.  The 5C's of an Age-Friendly Public Health Systems are;  Connecting and Convening with multiple sectors and professions to provide support, services, and infrastructure to promote healthy aging. Coordinating existing supports and services to avoid duplication of efforts, identify gaps, and increase access to services and supports. Collecting and Disseminating Data to assess community health status (including inequities) and the aging population needs to inform interventions. Communicating and disseminating research findings and best practices to support healthy aging. Complementing and supplementing existing support and services, particularly in integrating clinical and population health approaches.  "Public Health System Recognition Program is  designed to incentivize state and local public health departments to become age-friendly and take those steps needed to  transform their health departments to be age-friendly ones." -Megan Wolfe, JD  Want To Know More?  If you want to learn more, the Public Health Accreditation Board will be   considering healthy aging recommendations and has developed a Tip Sheet on how to get started to align healthy aging with the PHAB Standards and Measures. TFAH offers an informational  webinar on the Age-Friendly Public Health System Recognition Program. All state, territorial, local and tribal public health departments are eligible to enroll and participate in the Recognition program. You may also visit the Age-Friendly Public Health Systems website, and Megan Wolfe can be reached at mwolfe@tfah.org   COMING SOON is a stand-alone website for Age-Friendly Public Health Programs. So stay in touch and get connected! About Megan Wolfe Megan Wolfe is a Senior Policy Development Management at Trust for America's Health (TFAH), where she works with the Policy Development team to advance a modernized, accountable public health system.  Her current work at TFAH focuses on advancing Age-Friendly Public Health Systems. Megan has been engaged in public policy and advocacy for over 20 years and has represented Fortune 500 and non-profit organizations.  Before joining TFAH, she served as Government Relations Manager for ASCD, an international education association comprising teachers, principals, superintendents, and higher education professionals.  Her work experience also includes serving as Government Relations Manager for the National Association for Sport and Physical Education and as a staff member for the Senate Judiciary Committee working on the federal judgeship confirmation process.  Megan received her undergraduate degree in Government from the University of Texas at Austin and earned a JD from the Antonin Scalia Law School.      About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN:   I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.  

Mar 2

12 min 56 sec

Helping a Person With Alzheimer's Disease to Eat "Handfeeding is recommended over tube feeding in Alzheimer's disease. The handfeeding techniques offer an additional sensorimotor cue."  -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN In the late stages of Alzheimer's disease, it's not unusual for older adults to have trouble eating.  Before the end of life, 85% of people living with Alzheimer’s disease will have trouble eating. There are many reasons for this, but many stem from the sensory changes that happen with the disease such as changes with smell, taste, vision, and hearing. Other contributing factors may involve chewing their food, swallowing, or they simply lose interest in food.  Ensuring that anyone with Alzheimer's eats a healthy meal or eats sufficiently turns into a real practical and emotional challenge for the caregiver.  In today's episode of This Is Getting Old, we'll talk about Alzheimer's Care: Making Mealtimes Easier. I'll share strategies that can help you help an older adult to eat more food. Part One of 'Helping a Person With Alzheimer's Disease to Eat. ' The first step in understanding is the sensory changes that impact an older adult's ability to feed themselves.  These sensory changes are briefly described below;  Smell. Smell is diminished with Alzheimer's disease. As this disease progresses, people lose their sense of smell. They can't smell their body odor, they can't smell if there's smoke in the house, so they certainly have a hard time smelling food. This change also increases their risk for food poisoning.    Taste. Have you ever wondered why an older adult with Alzheimer's disease loves sweet food? Sugar fires up a part of your brain that remains intact throughout the disease. So if we need to put a little bit of sugar on somebody's food (and adjust their medical regimen accordingly if they have diabetes), to get them to eat more food, we should do that.  "For an older adult with Alzheimer's disease, adding a little bit of sugar to their food could be a good thing because sugar fires up a part of the brain that remains intact throughout the disease." -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN Hearing. If you only have Alzheimer's disease, you can still hear, but what happens is you lose the ability to use and understand language. It might seem like they can't hear us sometimes, but the reality is they can't understand us.    Vision. A person with Alzheimer’s disease will  lose peripheral vision. With Alzheimer's disease, vision diminishes from scuba vision, to binocular vision, down to monocular vision. Touch. The Palmer Reflex returns with late Alzehimer’s disease. The Palmar Reflex is similar to when you put your finger in the palm of a baby's hand, and they grab it. That reflex comes back very late in this disease, making it difficult for older adults to use utensils, handle cups, and all the things that it takes to feed themselves. Verbal and Visual Cues To Facilitate Ease in Feeding   When providing care to a person living with Alzheimer's disease, we already know to give people verbal and visual cues. However, late in the disease, they will have a hard time using and understanding language so what they pick up on is your nonverbal behavior.  So if you sit down and you're smiling, or you mimic chewing or whatever it is that you want them to do, that part of the brain remains intact even late in the disease (it’s called “Mirroring”). By using nonverbal cues, you're a lot more likely to get them to do what you want without using words.   Part Two of 'Helping a Person With Alzheimer's Disease to Eat.' Modified Hand-feeding Techniques In helping the older adult eat, the three hand-feeding techniques are Over Hand, Under Hand, and Direct Hand.  You should start with the least amount of assistance you need to provide and save using the Direct Handfeeding technique until last. Unfortunately, what we often see in practice is that people start and stay with Direct Hand. This can create unnecessary debility and dependence on others, rather than supporting self-feeding.    The first thing you need to know is if the person has“skill finger” ability (your thumb, first and second finger are your “skill fingers” and are needed to manipulate utensils when eating). Based on this information, you can tailor the level of assistance provided and which technique to use.  Over Hand  Let's say we have an older adult who's pretty much able to feed themselves that they have skill finger ability and need a little help getting the food from the plate to their mouths; start by offering overhand assistance. Place your hand over the person's and gently guide their hand with the utensil towards their mouth.    Be careful when you're doing this to make sure that you don't hurt their wrist or grab their hand too tight and always help them through the middle of their body.  "Hand-feeding techniques are helpful for other caregiving activities that you may be doing. You can help older adults brush their teeth, comb their hair, and even get dressed; because with the Under Hand technique, we're doing all the fine motor stuff that they can no longer do because of Alzheimer's disease." -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN Under Hand  The Under Hand technique works the best for someone who's lost skill finger ability or doesn't seem to understand what to do with their utensils. At this point, we can use the Under Hand technique.  Start by getting into the Under Hand Shake position; what this technique does is it frees up is your skill fingers. The Under Hand technique provides a new, additional sensorimotor cue to maximize the signals that we're providing.  Modifications based on Range of Motion Ability One of the first modifications we can do with the underhand technique is if the person has a partial range of motion. In this case, we need to load the fork or the spoon for them because that's the part that they can no longer do. So if a person has very little range of motion, you may need to put their food item into a different container and get very close to them so that they don't have to move as far to participate in the act of eating. Even with a minimal range of motion, the underhand still provides the cues that might help them to understand that it's time to eat  Direct Hand  The third technique is the Direct Hand technique. You want to save this handfeeding technique for people who aren't able to participate in the act of eating. It is best practice to put your hand on their shoulder; because they've lost peripheral vision and they may not see you sitting there. Even with this technique, you need to make sure that they see the food before it comes towards their mouth. Lifting it into their visual field helps them to know that food is coming, and usually results in them opening their mouth. This often allows meal intake to go more quickly. Want to Know More? If you found this video helpful and would like to learn more strategies to improve meal intake, please visit my website at MelissaBPhD.com/shop. I’ve created an online course titled, “Optimizing Nutrition in Dementia Using Supportive Handfeeding”. I’ve adapted this course from my research teaching nursing home staff for family/ friend caregivers to teach you these skills.  This course teaches you the most recent evidence-based information we have for managing mealtimes in dementia – and you may even find it helpful for doing other care activities like combing someone's hair, brushing their teeth, or helping them to get dressed.   You can use the Coupon Code TIGO20 to get 20% off the course! You can also find other videos related to Alzheimer's disease on my YouTube Channel (MelissaBPhD) and this website under podcasts + blogs. About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Feb 23

9 min 28 sec

The 4M's Framework: MENTATION with Tahira I. Lodhi MD "Mentation is about preventing, identifying, treating, and appropriately managing the 3Ds in geriatrics: dementia, delirium, and depression."-Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN “She’s just not right today”. When referring to an older adult, this simple phrase should be a signal to family and formal caregivers alike to begin to find out why.  If a child “wasn’t right” one day, no one would ignore it - and we cannot ignore it in an older adult. An altered mental state is a broad term for geriatric patients having issues with their cognitive level. Essentially, for older adults with altered mental states, early detection and diagnosis are essential, as the source could be life-threatening.  In line with that, today's episode of This Is Getting Old, will focus on continuing our special series on the Health Systems Initiative and the 4Ms Framework, explicitly talking about MENTATION.  Dr. Tahira I. Lodhi joins us, and we'll talk more about providing health care services to older adults with the limelight on the spheres of Mentation. Also check out these related podcasts: Ten Warning Signs of Dementia Six Tips for Talking to Someone You Think Has a Memory Problem How Dementia is Diagnosed Ten Tips for Preventing Alzheimer’s Disease How to Manage Repetitive Behaviors in Alzheimer’s Disease Part One of 'The 4M's Framework: MENTATION'. THE SPHERES OF MENTATION Mentation is about preventing, identifying, treating, and appropriately managing what is referred to as the 3D's in geriatrics; dementia, delirium, and depression. The 3D's are a cornerstone of geriatrics, and it can be challenging to tease these three apart when providing care to an older adult.  There are several characteristics in common with depression, dementia, and delirium. Apathy, detachment, and tearfulness can be present in both depression and delirium, especially hypoactive delirium. However, a reliable indicator lies with the onset and duration.  The onset of dementia is slow and insidious. However, deterioration is progressive over time. Delirium develops unexpectedly (for hours or days), and manifestations appear to fluctuate during the day. While a change in mood persisting for at least two weeks characterizes the onset of depression. The duration may coincide with life changes and can last for months or years. DELVING DEEPER INTO MENTATION DEPRESSION It is necessary to remember that depression is not an unavoidable aspect of becoming older, nor is it an indication of failure or character defects. Regardless of your history or past successes in life, it can happen to everyone, at any age. While life changes when you age, retirement, loved ones' demise, deteriorating health may also induce depression.   TOOLS FOR ASSESSING DEPRESSION For health care providers, it's essential to recognize depression. You can use several instruments, like PHQ-2, PHQ-9, and other Geriatric Depression Scales, to assess depression in older adults.  PHQ-2 (Patient Health Questionnaire-2) uses a valid and reliable depression screening tool for all ages. In comparison, a PHQ-9 is a screening test that can also be used to follow-up on a promising PHQ-2 outcome and to track response to therapy. "You may find that a person who was once active in the long-term care setting is now just sitting on the sidelines, not talking to anybody and say that they just feel down. That's the time to evaluate the person and make sure it's not depression." -Tahira I. Lodhi, MD SIGNS AND SYMPTOMS OF DEPRESSION IN OLDER ADULTS Recognizing depression starts with getting familiar with the signs and symptoms. Red flags for depression include: Sadness or feelings of hopelessness. Unexplained aches and aggravated pains Lack of interest in hobbies or socializing. Loss of weight or appetite. Feelings of desperation or helplessness. Lack of encouragement and energy. Sleep disruptions Slowed movement or discourse. Fixation on death; suicidal thoughts. Problems with memory. Neglecting personal treatment   WHAT TO DO: PREVENTIVE MEASURES AS FAMILY MEMBERS OR CAREGIVERS   To help older adults suffering from depression, you can evaluate psychological evaluation with or without starting SSRIs. Selective serotonin reuptake inhibitors (SSRIs) are prescribed for patients with mild to severe depression who initiate psychiatric treatment with an antidepressant. Among the countless antidepressants, SSRIs provide as much value in terms of efficacy and mitigating health risks.  Besides, SSRIs are the most commonly used antidepressants. Daily exercise can even help avoid depression and lift an older adult’s mood. Let them do everything that they want to do. Also, being physically healthy and consuming a healthy diet will help reduce ailments that may contribute to depression among older adults. Moreover, Psychotherapy, often referred to as "talk therapy," can help those with depression. Talk therapy is used to mitigate depression, and it works by assisting older adults to do away with harmful thoughts and any habits that could exacerbate depression. Part Two of 'The 4M's Framework: MENTATION'. DELIRIUM Delirium can be a medical urgency/emergency and can present as either hyperactive or hypoactive. Any sudden change in mental status should be considered delirium. The hallmark is in-attention. It can get tricky when a person already has a diagnosis of dementia - we refer to this as delirium superimposed on dementia. However, once we fix the delirium's underlying cause, the person will typically return to the baseline mental status. If you or a loved one are planning an elective surgery, be sure to review these considerations and discuss them with your provider and surgeon, in hopes of preventing postoperative delirium. Page 24 has a checklist of things that you and your provider should look for and many of the Confusion Assessment Methods (CAM), such as the CAM-ICU (p. 47). RECOGNIZING HYPOACTIVE DELIRIUM  AND HYPERACTIVE DELIRIUM Delirium progresses gradually, and the effects fluctuate throughout the day and worsen at night.  Hyperactive delirium is distinguished by Increased muscle movement, restlessness, anxiety, hostility, roaming, hyper-alertness, hallucinations, delusions, and inappropriate behavior.  On the other hand, Hypoactive delirium is characterized by reduced muscle movement, lethargy, withdrawal, drowsiness, and sleeping too much. SCREENING TOOLS THAT CAN BE USED TO ASSESS DELIRIUM Whether you're a family or caregiver of older adults at risk of or healing from delirium, you should take precautions to enhance the well-being of the individual better.  Assessment tools that may be used to test instances of delirium. Confusion Assessment Method (CAM) CAM-ICU for intensive care units 3D-CAM for medical-surgical units bCAM for emergency departments WHAT TO DO AS FAMILY MEMBERS The best thing you can do as a family member is to provide encouragement and orientation.  Remind the individual where they are, who they are, and also what time it is. It would also help if you alerted providers whenever delirium signs and symptoms are noticed in the patient. A matter of saying, "Mama just isn't right today." can make a difference.  WHAT TO DO AS PROVIDERS: PREVENTION STRATEGIES As a healthcare provider, you will play a critical part in having a positive and comforting presence during an older person's delirium.  Here are several straightforward steps to alleviate delirium and how you can help as a caregiver : Convey and resolve sensory disability. Use simple sentences to ask individual questions, and use interpreters where available. Minimizing the confusion of the patient. Place a large-font clock, calendars, and signs. Promote cognitive enhancement, such as learning about news or recalling. Discourage napping throughout the day to help the patient relax at night. Foster mobility and self-care Promote autonomy in everyday life tasks and minimize the possibility of crashes. Encourage patients to reduce the possibility of constipation, dehydration, and under-nutrition by eating and drinking. Consider calming, music, or massage therapies (this may also help with sleep). Stop using indwelling catheters because they can cause contamination. It is advised to minimize, stop or prevent the usage of psychoactive medications as they can aggravate delirium. Document the indications in the psychiatric background of the patient for the usage and stopping use of antipsychotic treatment Ensure that pain control is available and that a protocol for pain treatment is in effect. Keep the room silent, such as utilizing vibrating pagers instead of calling bells. "Recognizing delirium is the biggest thing. In some of the studies that I've seen, up to 60 to 75 % of health care providers don't recognize delirium." -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN DEMENTIA RECOGNIZING DEMENTIA Dementia is not a particular illness; it's a broad concept that encompasses a wide variety of serious medical issues, including Alzheimer's disease.   Abnormal brain shifts are triggered by diseases clustered under the general word "dementia." These transitions cause a reduction in reasoning skills, which are incredibly severe to affect everyday life and autonomous functioning. They also influence actions, thoughts, and relationships. Check out these related podcasts to learn more: Ten Warning Signs of Dementia Six Tips for Talking to Someone You Think Has a Memory Problem How Dementia is Diagnosed Ten Tips for Preventing Alzheimer’s Disease How to Manage Repetitive Behaviors in Alzheimer’s Disease SCREENING TOOLS USED TO ASSESS DEMENTIA A clinical evaluation, experimental testing, and the observation of the irregular shifts in thought, day-to-day function, and patient actions are needed by physicians to identify Alzheimer's and other forms of dementia.  But the precise form of dementia is more difficult to ascertain since the signs and brain alterations of multiple dementias may overlap. For health care providers, some of the screening tools that are commonly used are MMSE (Mini-Mental State Exam), MoCA (Montreal Cognitive Assessment for Dementia, and the SLUMS Test. WHAT TO DO AS FAMILY MEMBERS AND HEALTHCARE PROVIDERS You can take measures to improve cognitive health and reduce your loved one or patient's risk of dementia. Please encourage them to maintain an active mind by playing word puzzles, memory games, and reading. Being physically active, exercising at least once a week, and making other positive lifestyle improvements will also lower the risk. Lifestyle and dietary improvements include avoiding smoking and consuming a diet high in, Fatty Acids omega-3, Fruit, Vegetable, and whole grains.    About Tahira I. Lodhi MD  Tahira I. Lodhi, MD, is an assistant professor at the University of George Washington for Geriatrics and Palliative Care. In 1999, she graduated from medical school and received her Family Medicine training at Virginia Commonwealth University and her Geriatrics Fellowship Training at George Washington University. Dr. Lodhi's expertise is in the training and practice of primary care geriatrics. She's often involved in developing workflows in healthcare systems and supporting her patients to receive streamlined, patient-centered services.     About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN]:   I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.  

Feb 16

25 min 24 sec

The 4M's Framework: MOBILITY with Tahira I. Lodhi MD "MOBILITY is a critical aspect of the 4M's framework because you have to safely move every day to maintain your function - in order to do WHAT MATTERS."-Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN Strength and mobility are vital facets of life, but they are often taken for granted. When you experience a mobility restriction, that’s when people become more mindful of its value. For older adults, mobility issues are strongly linked to falls, social isolation, feelings of loneliness, stress, chronic disease, weight deterioration, and loss of bone mass. Mobility restrictions are also known predictors of mortality. Older adults prefer to be independent, but this may be difficult if they are experiencing mobility problems.  In today's episode, we will discuss MOBILITY as a continuation of our special series on the 4M's Framework of the Age-friendly Health Care Systems. With me is Dr. Tahira I. Lodhi, and we're inviting you to join us and discover how to implement MOBILITY in your care plan for older adults properly. Part One of 'The 4M's Framework: MOBILITY'. About Tahira I. Lodhi MD  Tahira I. Lodhi, MD, is an assistant professor at the University of George Washington for Geriatrics and Palliative Care. In 1999, she graduated from medical school and received her Family Medicine training at Virginia Commonwealth University and her Geriatrics Fellowship Training at George Washington University. Dr. Lodhi's expertise is in the training and practice of primary care geriatrics. She’s often involved in developing workflows in healthcare systems and aims to support her patients to receive streamlined, patient-centered services. What MOBILITY is All About?  When we say MOBILITY, we're talking about the movement of patients in their environment. It is an indicator of how well your patient can live independently in the community and their own homes.  Moreover, MOBILITY for older adults is about moving naturally. It's not like training for marathons. But the movement is essential. It has to do with how well they walk and their balance and strength—how well older adults can get around matters. "For every day that an older adult spends in bed, it takes them about three weeks to recover. So daily movement is essential." -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN. How to Maintain MOBILITY: What To Do and Things To Look Out For Awareness of Your Patient's Life Space Your patient's living space tells you how mobile or interactive they are with their surroundings. Care providers must know whether the patient is traveling in the community, taking public transport, going places, or confined to the home to assisted living or nursing home. That life space concept is essential to determine how functional your patients are. A clear understanding of your patient's life space minimizes the onset of disability in the future and has been associated with a decline in certain medical conditions like COPD (Chronic Obstructive Pulmonary Disease). Looking Out for Elements that may Cause Falls The primary goal of incorporating MOBILITY into older adults’ health care plans is for them to be independent and have ease in moving around. As their care providers, make sure the environment they are in is safe enough and there are not, for example, area rugs that could cause potential falls. See to it that your patients have spaces where they can move around in their environment. Likewise, consider your patient's engagement with the broader community, their neighborhood, and also within their own home. These are built environments that need safety assessments. Like how safe are the sidewalks? Do they need adaptive equipment?  Encourage Daily Movement Another way to maintain MOBILITY among older adults is by encouraging them to move daily. Any increased activity level from baseline is best, but the goals and targets for older adults are 30 minutes of regular to moderate level physical activity, five days a week.  That could be something as simple as walking on a level surface for 30 minutes a day. "What I tell my patients is if they aren't doing that level of activity, they can start with as low as five minutes a day and build it up slowly," says Dr. Tahira I. Lodhi Take Advantage of Technology to Monitor the MOBILITY In helping your patients reach the goal of walking at least 30 minutes continuously, some technologies can help. An Apple Watch, for instance, will tell you when it's time for them to get up and do something.  Both the Apple watch and FitBits, when worn on the wrist, monitor the number of steps taken, prompts the user to walk, documents sleep, and in some versions analyzes heart rates. Managing Impairments that Reduces MOBILITY Some medications may have side effects that reduce MOBILITY. This goes true with patients who are on blood pressure medications. It would be best if you check on your patient and ensure they're not getting dizzy when they get up from a seated position. Because of all the risks,  secure the lighting for them to see clearly if they're using glasses, and they can walk around easily. Furthermore, teach and educate your patients about mobility devices if they're using one: these devices are their friends.  Part Two of 'The 4M's Framework: MOBILITY'. Assessment Care Providers Can Use to Gauge MOBILITY  There are several assessments that care providers can use to gauge an older adult’s mobility. Three of the commonly used tools are the Timed Get Up and Go, Fall Risk Assessment, and Home Safety Assessment.  Timed Get Up and Go The Timed Get Up and Go (TUG) assessment is a practical mobility performance-based test primarily used in older adults to diagnose mobility and balance impediments.  The test allows the patient to rise from a chair, move 3 meters to a target set on the floor at a comfortable rate, turn around the 3-meter marker, walk back to the starting position, and return to sitting in the chair. The test score is the duration it takes for the patient to complete the test.  Fall Risk Assessment The American Geriatrics Society and British Geriatrics Society issued guidance for clinical practice on fall risk screening, evaluation, and treatment.  The guidelines advise that all individuals 65 years of age and older be tested regularly for fall risk(s). This assessment involves asking patients if they have collapsed two or more times over the past year, have pursued medical treatment after a fall; or if they appear unsteady while moving if they have not fallen.  There is an elevated likelihood of declines among patients who react positively to these concerns and may undergo more evaluation. People who have fallen previously without damage must have their posture and gait assessed. Also, providers should do a further assessment of those with gait or balance abnormalities.   Home Safety Assessment As healthcare providers, your patient's home needs to be safe for them to move around.  To do that, it would be best for family members or caregivers to implement the following suggestions: Be sure that hallways, staircases, and ramps are well illuminated. Some rails and banisters can be used when moving up and down the stairs.  Never put scattered rugs at the base or top of the stairs.      Secure rugs and carpets to the floor such that they do not move as you step on them. Use double-sided tapes to fasten area rugs. Rearrange furniture to make way for unobstructed walking pathways.  Make light switches accessible by positioning them not so high.   Enhance overall home illumination. Wherever possible, add work lights and night lights. Use levered handles to replace doorknobs or install doorknob grips. In a high-contrast color, label differences in floor area with paint or tapes.  Remove any electronic wire and extension cables passing across or around walkways. Place electrical cords behind the furniture, if possible. To enable shifting from sit-to-stand smoother, swap precarious chairs with chairs that have strong sides. "Movement is important; it has something to do with how well you walk and your balance and strength. How well you can get around matters."   -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN Intervene Effectively After completing mobility assessment procedures, follow up with patient-specific interventions to help older adults address modifiable risk factors and stay safe.  Here’s what you can do to intervene effectively; Refer your Patients to Physical Therapy  Physical therapy helps preserve the flexibility of older adults, whether treating long-term conditions or maintaining fitness and mobility. The aim of physical therapy is always to regain and strengthen functionality, minimize discomfort and enhance mobility. Suggests Personal Adaptive Equipment to Promote MOBILITY  Assistive devices cover aids like canes and walkers and sophisticated structures like computer applications and motorized wheelchairs. It's beneficial to consider this broad range of assistive technologies and choose what best fits your patient's needs.  Mobility devices that assist patients in moving or walking include:   canes crutches  tricycles walkers walking frames Also, having a medical alert system in operation can ease any burden on caregivers and families. This system immediately alerts family members or caregivers whenever something's wrong with the patient. Most medical alert systems provide functions such as an instant update if a fall is detected. Recommend the HELP (Hospital Older Elder Program) Mobility Change Package and Toolkit The Mobility Change Package and Toolkit was developed in collaboration with The Hospital Elder Life Program(HELP) and Health and Aging Policy Fellowship. It is a structure, blueprint, and step-by-step guide for executing a mobility initiative. The program contains a comprehensive toolkit, including mobility guidelines, instructions for monitoring and documenting mobility results, model patient brochures, target indicators, and accounts from platforms with valuable Mobility Programs. About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN]: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Feb 9

18 min 22 sec

The 4M's Framework: WHAT MATTERS with Tahira I. Lodhi MD "WHAT MATTERS means knowing what's important to an older adult, so that we can align care to specific health outcomes and the care preferences that are including but not limited to end of life care and across all care settings." -Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN Everyone involved in healthcare has their hands full most of the time—especially with COVID-19.  Health care providers in an Age-Friendly Health System should ask older adults WHAT MATTERS to them - regardless of the care setting.    Today we are continuing the special series on the Age-Friendly Health Systems initiative and the 4M's Framework, explicitly discussing WHAT MATTERS.  Dr. Tahira Lodhi joins me, and she'll be expounding more about WHAT MATTERS as a vital component of an Age-Friendly Health System. Part One of ‘The 4M's Framework: WHAT MATTERS'. About Tahira I. Lodhi MD Tahira I. Lodhi, MD, is an assistant professor in Geriatrics and Palliative Care at George Washington University. She graduated from medical school in 1999 and received her Family Medicine training at Virginia Commonwealth University and Geriatrics Fellowship Training at George Washington University.  Dr. Lodhi's interest is in geriatric primary care practice and teaching. Since graduating from Fellowship in Geriatrics in 2011, she has had medical students, residents, and fellows join her in traditional and non-traditional settings. These include hospitals, clinics, classrooms, assisted living, and post-acute long-term care settings. Aside from that, she's also interested in workflow improvement in healthcare systems by deploying available technology. Her goal is to help her patients get simplified, patient-centered care while collaborating with an interdisciplinary team. A Closer Look at WHAT MATTERS of the 4M's Framework WHAT MATTERS means to know and align care with the older adult's specific health outcome goals and care preferences, including, but not limited to, end-of-life care and across care settings. Why WHAT MATTERS is an Integral Aspect of Care? When asked about this question, Dr. Tahira Lodhi explained that without WHAT MATTERS of the 4M's Framework, health care providers often lose sight of their patient's priorities.  She said, "I can sit here and prescribe whatever I want, but if my patient is not taking it, then I don't change anything. The outcomes do not change." Creating that partnership with your patient is imperative to know what's essential for them as providers.  If you don't ask your patients what matters to them, you won't answer that question of their health. All of these play a role in WHAT MATTERS for your patients.  "Having conversations at a human level with your patient is very important. Keep in mind that your patient is not the labs or the diseases or diagnosis they have. They're a human being who wants to have a conversation with another human being."   —Tahira Lodhi, MD   How to Initiate Conversation? As a healthcare provider, in initiating conversations with your patients, keep in mind that this may not be one conversation that you can complete in one visit or one sitting. The critical piece is to start having those discussions. Your patients will appreciate it if you’re more open to communicating with them. Start having conversations as simple as; What is most important to you? What can I do for you as a provider?  What do you want me to do to help you make your quality of life better?  Ask them if they miss a medication dose. What do you want to focus on while you are in the nursing home so that you can visit your grandchildren more often? What are your most important goals in case your health situation worsens? Part Two of 'The 4M's Framework: WHAT MATTERS'. The Essence of Documenting WHAT MATTERS to your Patients It's crucial to document WHAT MATTERS to your patient, especially in your EHR (electronic health record). Also, when you organize your care plan around the 4M's, it easier for other providers to know which part to go to when they sift through the medical records.  Putting it in a place where other providers can see it quickly would be very important. Places, where you can put it, could be on a whiteboard for your patient in assisted living or a nursing home setting.   What to Include in the Documentation?   Preferred name Preferred Pronouns Favorite Foods Favorite Activities Things that comfort the older adult Assistive Devices needed (glasses, dentures, hearing aids) Names and phone numbers of family members/ caregivers "Care providers sometimes put our agenda aside. Our agenda doesn't matter so much if the person is unwilling or not ready to talk to us (about What Matters)." - Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN What may Matter to an Older Adult and their Family?   It's essential to have information about WHAT MATTERS to an older adult and their family so that in cases of emergency, responders who don't know the patient can access that information and avoid an adverse outcome.  Examples of usual events or activities that may matter to an older adult and their family are;     Babysitting a grandchild Walking/ exercising/ socializing with friends/ family Continuing to work or volunteer Life milestones (births, graduations, annual family celebrations) Travel Plans Birthdays Holidays Anniversaries The Role of the Family  Geriatrics and palliative care are always interdisciplinary, and there's always a team that is taking care of your patient. That team includes not only your patient but their family members and their caregivers. Please make sure they are a part of the conversation. While it's okay to include family members, be sure that the older adult is also asked WHAT MATTERS to them. Implementing WHAT MATTERS to Older Adults with Cognitive Impairment or Alzheimer's Disease   In instances where the patient or an older adult cannot communicate for themselves, their advocates can. As healthcare providers, you should be advocates for your patients in all different settings. For your patients who are not cognitively intact for any reason, maybe acute change, possibly chronic memory deficits, then their next of kin or power of attorneys should be aware of WHAT MATTERS to their patient. That way, they can make appropriate decisions for your patient according to what your patient wants and not what everyone dictates.   About Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN]: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor, where I am also the Director of the GW Center for Aging, Health, and Humanities. Find out more about her work at https://melissabphd.com/.  

Feb 2

17 min 7 sec

The 4M's Framework: MEDICATION with Ayo Bankole PhD, RN and Tahira I. Lodhi MD   "Do the Brown Bag with your pharmacist too; because there are drug-drug interactions, drug-food interactions, and drug-supplement interactions to be aware of. Make sure that you're very clear about everything you are taking"    — Melissa Batchelor, PhD, RN, FNP-BC, FGSA, FAAN  _________________________________________________________________________________________________   We all hear about the increasing rates of health care services and how costly prescription medications can be, especially for older adults. But these costs can grow higher if you don't take the prescription correctly. The figures are especially troubling for older adults. Roughly 23% of nursing home admissions are attributed to an older individual's failure to self-manage their prescribed drugs at home. About 21% of drug-related health problems are induced by patients, whether by mistake or failing to stick to their prescription regimens. Also, while having their medicines, up to 58 % of older adults commit some fundamental mistake, with 26% committing errors. These statistics are alarming, and that is the primary reason why Medication is such a critical part of the 4M's Framework and part the Age-Friendly Systems are highly encouraged in nursing homes and health care systems. In today's episode, we are joined by Drs. Ayo Bankole PhD, RN, and Tahira I. Lodhi, MD. Join us as we engage in meaningful discussions about one component of the 4M's Framework: Medication and learn how to make sure that your medications are age-friendly.    Part One of 'The 4M's Framework: MEDICATION'.   Overview of Medication as an Essential Component of the 4M's Framework    In implementing the 4M's Framework to achieve an age-friendly healthcare system, we want to ensure that Medication does not interfere with the other M's, which are: What Matters, Mentation and Mobility across care settings. To do that, we should have a clear definition of the terms associated with the medication. Two of these terms are polypharmacy and medication reconciliation.  What is Polypharmacy?   Tahira I. Lodhi MD explained that polypharmacy is too many medications in simple terms. She also said that when you see a patient with a medication that does not have a corresponding diagnosis documented, that's also polypharmacy by one definition.    "Whichever situation you are in, whether you are by the bedside in the hospital, in outpatient or long-term care settings, be very aware of the definitions of polypharmacy and be ready to address them." -Tahira I. Lodhi, MD (03:21-03:35)   What is Medication Reconciliation?   Ayo Bankole, PhD, RN, expounded that medication reconciliation involves reviewing the medications a patient is taking and comparing them to the medicines on file. Medication reconciliation ensures no discrepancies, such as medication duplication, missing prescriptions, and inappropriate medications.     Patient Education: Things to Look for or to Report to a Provider   Use a Medication Administration Sheet   When you get that medication list from the hospital or your provider, it often comes in a list. This can be overwhelming, so using a “real time” document can help reduce medication errors - particularly if there is more than one person trying to help the older adult. Write down your medications in the order you would need to take them in a day, rather than trying to use the list in the format typically given to patients. And write  [Can we link this form? https://drive.google.com/drive/u/1/folders/11CoEC6kj3bRw7k4yFHdjgTxIS8WqqYVD] Crystal - we created this document for EP21, but doesn’t seem to be included in the brand article?  Keep a Medication List   With that, Ayo Bankole PhD, RN suggests keeping a medication list. Your medication list should include the following; Any medications you're taking, and this includes vitamins and supplements or herbal supplements. The medication list is not only the medicines that are prescribed by a physician or a nurse practitioner. It also includes other medications that might be over-the-counter supplements that your patient might be taking. Include the name of the medications you are taking, the dose, and where the medicine is used. Include the name of the prescribing doctor  Have phone numbers of your pharmacist or your doctors on the list as well.    Teach the “Brown Bag” Review   Aside from keeping medication lists, Tahira I. Lodhi MD also suggests teaching patients the Brown Bag review. She pointed out that doing the Brown Bag Review leads your patient to gather all the medications, put them in the bag, and bring them on every visit. Once they are in the clinic, either your medical assistant or you take out those medications, put them on a table where the patient can see them.    The review brings you and your patient on the same page about what medications they are taking, what supplements they are taking, etc. This is an excellent opportunity to know whether your patient is aware of why they're taking this medicine, what doses they're taking. Furthermore, Brown Bag Review is a unique tool a provider can use to avoid polypharmacy in their patients.    What To Look For Or Report To Providers?   For patients experiencing polypharmacy, monitoring for any side effects and signs and symptoms is essential.  The following are the signs to look out for and should be reported to providers ASAP; Loss of appetite Diarrhea Fatigue  Weakness Change in mental status Confusion Hallucinations  Changing mood and behavior   Part Two of 'The 4M's Framework: MEDICATION'.   Medication Assessment   For the second part of the interview, Drs. Lodhi and Bankole mentioned Medication Assessments. They shared that there are assessments or tools students or practicing providers can use when prescribing medications to older adults. These criteria are validated tools and are widely used. Two of them are Beer's criteria and the STOPP and START criteria.   Beer's Criteria  Beer's Criteria for medications is a medication list that is put out by the American Geriatric Society. This is a list of potentially inappropriate medications for older adults. These medications carry different side effects, potential complications, and medication interactions, which account for many adverse drug reactions in the more aging adult population.  "I would tell students to be careful about Beer's criteria. The list of medications doesn't mean they are contraindicated. It means they are to be used very carefully, to be prescribed very carefully."- Tahira I. Lodhi MD(14:02-14:19) STOPP and START Criteria STOPP (Screening Tool of Older Persons' Prescriptions) and START (Screening Tool to Alert to Right Treatment) are more commonly used in Europe and was developed by the European Consensus Group. Still, it could also be used by providers and practitioners in the United States.  The STOPP criteria are similar to the specifications of medications that could be stopped or suggest medicines for discontinuation. On the other hand, the START part is the right treatment. Those are the recommended treatments for older adults, including the pneumonia vaccine and those recommended treatments for the more aging adult population.  Interventions and Best Practices After you've done a medication reconciliation and reviewed the Beers Criteria, Dr. Lodhi shared some of the best practices that providers can use.   Deprescribing (both dose reduction and medication discontinuation)   First, she advised that you should look at the medications the patient is taking. Make sure there is no polypharmacy. Then, be ready to adjust the dose on every visit. Assess how they are doing in terms of the medication. For example, with antihypertensive, look at the patient's self-monitoring of blood pressure. If it's consistently on the low side or there are signs of orthostatic hypotension, decrease the dose and at the same time have a plan of how you're going to follow in the future.     Pharmacy Consult   Secondly, Dr. Lodhi stressed out that your pharmacist is your friend and never hesitate to call them. She says, "Your pharmacists oversee your patient's prescriptions. They regularly make their recommendations because it's regular monitoring and quality control in long-term care settings." So make sure you reach out to your pharmacist frequently.   Re-evaluate on each visit with every provider   Lastly, Dr. Lodhi emphasized that every provider should guarantee that the medications are used as prescribed. Moreover, providers should also ensure that they'll go back to the patient's chart whenever they're asked to refill a prescription. They should always double-check for schedules and indications when to continue medications.  About Tahira I. Lodhi MD  I graduated from medical school in 1999. My Family Medicine training was at Virginia Commonwealth University and Geriatrics fellowship training at George Washington University.  My interest is Geriatrics primary care practice and teaching. Since graduating from Fellowship in Geriatrics in 2011, I have had medical students, residents and fellows join me in traditional and non-traditional settings, including hospital, clinic and classrooms but also assisted living, post-acute and long term care settings. I am also interested in workflow improvement through deploying available technology. My goal is to help my patients get simplified, patient-centered care, while collaborating with an interdisciplinary team.  About Ayo Okanlawon Bankole Ph.D, RN Ayo Okanlawon Bankole Ph.D, RN is a clinical assistant professor at GW Nursing. She is also one of the faculty members affiliated with the George Washington University/Medstar Washington Hospital Center academic partnership and scholarship program, W-squared. Dr. Bankole has practiced as a nurse in multiple areas within the acute care and community care setting. She is also committed to nursing education and she has been teaching nursing students since 2013 (in both part-time adjunct and full time appointments). Dr. Bankole's overall research goal is to contribute to research that improves health outcomes and wellbeing for older adults with complex healthcare needs. Her specific research interest are: aging, chronic disease self-management, theoretical approaches to chronic disease self-management and multi-morbidity.  About Melissa Batchelor, PhD, RN, FNP,  FGSA, FAAN I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor, where I am also the Director of the GW Center for Aging, Health, and Humanities. Find out more about her work at https://melissabphd.com/. References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234383/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573668/

Jan 26

24 min 3 sec

Age-Friendly Health Systems: History and Overview "Age-friendly Health Systems create a system of care where there's good communication, good leadership, and information systems that track across (care settings)."— Alice Bonner, PhD, RN With nine years to go before the last Baby Boomers reach age 65, our nation is on a short timeline to develop the infrastructure needed to provide quality care for older adults in our hospitals and health care systems.  With that vision in mind, a system of "age-friendly environments" is emerging from the collaborative efforts between the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA). The first podcast interview for This is Getting Old: Moving Towards an Age-Friendly World was with Dr. Terry Fulmer who has led development of the Age-Friendly Health Systems initiative (Episode 3). Building on that interview, in this episode, Dr. Alice Bonner shares the history and an overview of the Age-Friendly Health Systems. The goal of the age-friendly health system is to guide development of an infastructure required for hospitals and health systems to deliver evidence-based care for all - not just for older adults. Discover how the system empowers all health care settings to implement the 4M’s Framework to facilitate care for older adults. Part One of 'Age-Friendly Health Systems: Evidence-Based Care for All Older Adults'  Age-Friendly Health Systems: A History And Overview The Age-Friendly Health Systems: Evidence-Based Care for All Older Adults offers healthcare systems opportunities to help older adults residing within them. The model further emphasizes that societies must strive to counter age-based stigma, referred to as ageism, towards elderlies. This is to encourage independence for older people and to implement strategies that promote healthy aging. The idea came about from several organizations and individuals who look at the current health system, the current system of communities and public health, and how healthcare facilities are run.  They brought together expert clinicians, researchers, and people who spent their lives working with older adults. They started doing a big review of the literature and combed through several references. They've found that there are 90 elements of care guided explicitly toward older people's best care. They did lots of brainstorming, had meetings, and repeatedly went over the literature until they got down from 90 elements to 13 elements. Then everybody said, "13 things are just too many things to ask nurses and doctors and social workers to do". So they got together in a room and didn't come out until they had called it down to four elements, and those four elements all start with the letter M. What Matters? Medications, Mobility, and Mentation. "Age-friendly health systems allow people to customize; it promotes leadership; it requires leadership. And not just a medical director, but nursing leadership, social work, leadership, pharmacy leadership. It's about the interprofessional team."- Alice Bonner, PhD, RN  Age-Friendly Care – 4Ms Framework The 4M's are the core practices that clinicians believed to make a difference in administering care. Alice emphasized that health systems should implement these 4Ms accurately. According to her, "By addressing these 4Ms, we're talking about assessing people and then acting on those assessments. It isn't enough to do an assessment and put a piece of paper in the chart. What you want to do is say, "Okay, how can we act on this?" The Age-Friendly Care Systems 4Ms frameworks evolve on the following concepts:   What Matters   Know and align care with each older adult's specific health outcome goals and care preferences, including end-of-life care and across settings of care.    Medication   If medication is necessary, use age-friendly medication that does not interfere with What Matters to the older adult, mobility, or mentation across the setting of care.   Mentation   Prevent, identify, treat, and manage dementia, depression, and delirium across care settings.   Mobility   Ensure that older adults move safely every day to maintain function and do What Matters. Part Two of ''Age-Friendly Health Systems: Evidence-Based Care for All Older Adults’  The Principles Behind Age-Friendly Health System   Alice further stressed that most people are not thinking about ageism and includes stereotyped beliefs that discriminate against older adults. It’s not widely recognized, until it happens to you or someone you love.  Age-friendly systems look at how workers at health systems speak, the language they use, the references they make, and how they handle ageism and get rid of it. The Frameworks Institute has several resources and reports to help you learn more about how to effectively counter ageism. That is the primary reason why the forerunners of the 4Ms framework of the age-friendly systems anchored the system on the following principles. The 4Ms are set to be integrated into care for every adult ages 65 and older during every inpatient stay for over a year in a primary care setting.   Age-Friendly Health Systems and the 4Ms are a framework to organize the efficient, reliable delivery of effective care with older adults.  The framework is intended to be an infrastructure that builds on the care you provide today.  Age-Friendly Health Systems are designed to close the gap between the evidence-based care that we know works and the reliable practice of that care with every older adult in every interaction. "We started with five health systems. We're now at over a thousand health systems across the country, which is pretty miraculous for a three or four-year project. And the goal is to make it not just a project but to make it sustainable in the way we deliver care everywhere, all the time, every day." — Alice Bonner, PhD, RN Why Should Health Systems Implement The 4Ms Framework? As of December 2020, over 1,000 hospitals, outpatient practices, retail-clinics, and post-acute long-term care communities have been recognized as working to become Age-Friendly Health Systems. Having described a detailed 4Ms approach in their setting, 178 of these have been identified as Committed to Care Excellence as exemplar sites working toward the 4Ms reliable practice. What Are Participants Saying? There's always measurement involved in being recognized as an age-friendly health system. You or your organization can participate by signing up and joining an active community.  Here are what some of the participants are saying about 4M's Framework of the Age-friendly System.  "My hospital joined the movement and was recognized as an Age-Friendly Health System Participant after sharing with IHI how we are putting the 4Ms into practice. I'm going to encourage my doctor's office to join, too. " "IHI recognized us as leaders in the movement, and as an Age-Friendly Health System Committed to Care Excellence when we shared three months of data on the number of older adults, we cared for with the 4Ms." About Melissa Batchelor, PhD, RN, FNP, FAAN: I earned my Bachelor of Science in Nursing ('96'96) and Master of Science in Nursing ('00'00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11'11) and then joined the Duke University School of Nursing faculty as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Find out more about her work at https://melissabphd.com/.

Jan 19

27 min 10 sec

Introducing the AHRQ ECHO National Nursing Home COVID-19 Action Network  "The goal of the COVID-19 Action Network is to collaboratively advance improvements in COVID-19 prevention and infection management.”— Alice Bonner, Ph.D., RN Covid-19 exacerbated nursing homes' conditions; everyone was taken aback and did not anticipate the virus's overwhelming spread. It brought unprecedented challenges to nursing homes, considering older adults and immunocompromised patients are more vulnerable to the virus.   With that, the call for nursing homes to adapt changes in administering care amidst the pandemic is necessary and urgent.  In this episode, Alice Bonner will share with you what the Covid-19 Action Network is doing to advance improvements in COVID-19 prevention and infection management in nursing homes during this pandemic. Discover how they are actively recruiting training centers (health systems) and nursing homes worldwide to join in on promoting health and well-being of residents and staff.  Part One of 'National Nursing Home COVID-19 Action Network’  What Is Covid-19 Action Network All About? Alice Bonner is a senior adviser for the aging at the Institute for Health Care Improvement (IHI) in Boston, Massachusetts, and is also an adjunct faculty at Johns Hopkins University.   With her expertise in the field, Alice Bonner in collaboration with IHI and Project ECHO and with the support from the CARES Act Provider Relief Fund for Nursing Homes, and the Agency for Healthcare Research and Quality (AHRQ) launched the COVID-19 Action Network.  “Supported by the federal Agency for Healthcare Research and Quality (AHRQ) and in collaboration with the Institute for Healthcare Improvement (IHI), Project ECHO is launching a National Nursing Home COVID-19 Action Network.” -Alice Bonner, Ph.D., RN What Are The Goals Of the Covid-19 Action Network? The Covid-19 Action Network program aims to promote the health and well-being of nursing home residents and staff.  Towards that end, they've been recruiting Training Centers to provide interactive training to nursing home staff.  The primary goal of which is to advance improvements in COVID-19 prevention and infection control.  Specifically, the program implement evidence-based best practices to help nursing homes;  Keep the  Coronavirus out.  Identify residents and staff who have been infected with the virus early. Prevent the spread of the virus among staff, residents, and visitors.  Provide safe, appropriate care to residents with mild and asymptomatic cases.  Ensure staff practice safety measures to protect residents and themselves.  Reduce social isolation for residents, families, and staff. Part Two of 'National Nursing Home COVID-19 Action Network’  How Are The Covid-19 Action Network Goals Achieved? Alice highlighted that Covid-19 Action Network is not a model where a bunch of experts swoop in and say, "We're going to do all these webinars and give you all this important information." Instead, it's an all teach and all learn style of interacting among nursing homes.  Thus, to achieve their goals, the collaborators walked the extra mile to;  Provide no-cost training and mentorship to thousands of nursing homes nationwide. Create a virtual learning community where nursing home staff can learn from experts and each other to expand the use of proven best practices. The COVID-19 Action Network's Approach  The team comes up with a COVID-19 Action Network's Approach, which includes weekly sessions over 16 weeks. The virtual sessions are in concise presentation coupled with case-based learning and discussion. Essentially, these sessions are facilitated by small interprofessional teams of subject matter and quality improvement experts.  On top of that, there will be a sharing of best practices that nursing home staff can implement immediately. Furthermore, the sessions follow a standardized curriculum updated regularly to reflect new evidence and best practices.  The highlights of the curriculum are; PPE current practices Infection management practices COVID-19 testing Clinical management of asymptomatic and mild cases Minimizing the spread of COVID-19 Managing social isolation "What nursing home staff need is the skill set of how to talk with families, how to think about the questions to ask, and how actually to improve systems of care and workflow." — Alice Bonner, Ph.D., RN Why Should Nursing Homes Participate? Alice believes that nursing home staff are stretched and strained because of the pandemic.  Project ECHO and Covid-19 Action Network inspires and motivates people who work in long-term care to take charge and be the champions and be the leaders.  They're encouraged to participate so they can gain practical information, skills, and resources to deal with the prevention and management of the Coronavirus. In joining the program, they'll be a part of a virtual learning community of specialists and peers.  Plus, the good thing about it is that participation is free and voluntary. Moreover, nursing homes that participate will receive $6,000 to compensate for staff time. Nursing homes can join through their local training center or by using The Project Echo form through January 2021. If you have enrolled with a training center, there is no need to fill out our form.  Nursing homes, sign up here if you haven’t already enrolled with a Training Center: https://hsc.unm.edu/echo/institute-programs/nursing-home/pages/ Questions? Email Alice Bonner: abonner@ihi.org Resources Mentioned In Podcast:   CDC Long-Term Care Facility Toolkit AHCA/NCAL's #GetVaccinated Campaign Leading Age Vaccination Toolkit   About Melissa Batchelor, Ph.D., RN, FNP, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my Ph.D. in Nursing and a post master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor, where I am also the Director of the GW Center for Aging, Health, and Humanities. Find out more about her work at https://melissabphd.com/.

Jan 5

26 min 25 sec

Getting Organized: Managing Your To-Do List  "Make one year, three year, and five-year goals." — Melissa Batchelor, Ph.D, RN, FNP, FAAN  The New Year is almost upon us; this means it’s time to start out new and fresh and make some New Year's resolutions. One resolution that many people make is to get organized - to minimize the chaos in their work lives. In this episode, I’ll walk you through how I think about time and how you could apply it to managing your master, weekly, and daily to-do lists (all while making it fun)!  Steps To Getting Organized: Managing Your To-Do List When I was a doctoral student, I had to create professional development plans for several fellowships. This is a good idea because it helps you to get your thoughts organized by academic year. If you are also an academic or student,  you have to create a plan and usually by semesters for the academic year: Fall, Winter, Spring, Summer. Or, if you are in the business world, you might think of time in quarters for business planning.     Annual + Semester Planning. Make one year, three years, and five-year goals and map out steps needed to get there. You will need to plan out the goals that you want to achieve on a daily, weekly, monthly, and quarterly time frame - but also plan out the activities that you need to do. Be thinking ahead about the things you need to be doing a year in advance so that you’re ready when it's time to start the work to meet that goal.        Create a Master To-Do List.  I organize my Master To-Do List by project and category - as an academic, we have three main areas for our work: Research/ Scholarship, Teaching and Service. I track each project and all the different tasks that I need to complete with the due dates on this Master Plan.      I’ve tried both electronic-based and paper-based organizers. Ultimately, I’ve ended up using a hybrid model. My electronic calendar keeps up with my meetings and schedule but I like to use paper to track my To Do List. The act of writing things down helps me to remember what projects I have going on for any given semester.      Weekly To-Do List. Usually, at the beginning of the week, I will create a Weekly To-Do list. This list will include all of my meetings (for work) but will also include any errands (for home). I like to reference my calendar for weekly meetings.         Daily To-Do List + Incoming. It’s so important to keep track of    what you need to do each day as well. In the Daily To-Do list, I add my top 3 priorities for the day and also write down any New Tasks as they come in. I love to use sticky notes for the Daily To-Do lists.         Keep it Fun: Creativity in Aging. #NerdAlert!!  I am a HUGE fan of school supplies (pens, pencils, post-its, etc). Use whatever makes it fun for you whether that be color-coded paper or pens.    If you have any tips or tricks that you'd like to share about how you manage your To-Do list or how you get things done again, drop them into the comment box below the YouTube video or send me a message: https://melissabphd.com/contact/. If you enjoyed this episode, please let me know, and maybe I will do more podcasts on How to Get Organized and manage your time to increase productivity! About Melissa Batchelor, PhD, RN, FNP, FAAN: I earned my Bachelor of Science in Nursing (‘96) and Master of Science in Nursing (‘00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post-Master’s Certificate in Nursing Education from the Medical University of South Carolina College of Nursing (’11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health and Humanities. Find out more about her work at https://melissabphd.com/.

Dec 2020

6 min 59 sec

How to Manage Repetitive Behaviors in Alzheimer's Disease “Look for a reason behind the repetition.”— Melissa Batchelor, PhD, RN, FNP, FAAN  Are you wondering why a person with dementia develops repetitive behaviors like asking you the same question, telling you the same story, or doing the same thing over and over again? Knowledge is power. In this episode, I’ll walk you through brain development, what’s lost and retained in Alzhiemer’s disease, and help you problem-solve how to manage repetitive behaviors in a person with dementia using the C3P Problem-Solving Framework to explain. Part One of ‘How to Manage Repetitive Behaviors in Alzheimer's Disease’ To put it simply, your brain develops from the back to the front.  The back part of your brain is where your feelings and emotions are (the amygdala). The amygdala controls our emotional responses when we encounter anything threatening, and activates the sympathetic nervous system with the fight, fright, or flight response.  The front part of your brain is called your frontal lobe, and it doesn't fully develop until you're about twenty-five years old. This part of your brain is basically the “stop sign” - meaning when something comes to mind that you want to say, your frontal lobe might say, "No, don't say that quite yet (or don't say it at all)."  What happens with Alzheimer's disease is the brain loses its ability from the front to the back. So you lose your ability to control impulses, use and understand language but  your emotions remain intact throughout the disease process. “Focus on the emotion, not the behavior.” — Melissa Batchelor, PhD, RN, FNP, FAAN  To give you a visual image of what happens to the brain in Alzheimers. Imagine a grape, that's what a healthy brain looks like. When your brain is healthy, all of the messages can get back and forth without a problem. But what happens with Alzheimer's disease is the brain begins to shrink and shrivel.  Alzheimer’s disease basically turns your brain into a raisin. Imagine a raisin. There are deep crevices, and those crevices make it hard for the messages to get back and forth. This is why people lose their memory, decision-making ability, and the hardest thing is that they lose their ability to use and understand language. So our words basically end up sounding like Charlie Brown’s teacher -  So words don’t work anymore; but the person does pick up on our emotions and our non-verbal behavior. They will “mirror” us. Part Two of ‘How to Manage Repetitive Behaviors in Alzheimer's Disease’ Let’s talk about the C3P Problem-solving Framework focused on Changing the Person, Changing the People, or Changing the Place. The reason this is important is because there isn’t one thing that will work for any specific behavior. You will have to try different things for behaviors because what works today,  may not work tomorrow. You need a “bag of tricks” and a way to think through the three levels that will help you find a solution. Change the Person (with Dementia): Look for a reason behind the repetition. Does the repetition occur around certain people or surroundings, or at a certain time of day? Is the person trying to communicate something? Is the person trying to do something? Trying to understand what the underlying reason is can be helpful. Focus on the emotion, not the behavior. Rather than reacting to what the person is doing, think about how he or she is feeling. Try to figure out the root cause of his or her anxiety can help them manage their anxiety and maybe resolve it. For example, if an older adult said something fifty times already, rather than saying “you’ve already told me that 50 times!” [in a frustrated voice], say something like, “It sounds like you’re anxious.” [in a calm voice]. Turn the action or behavior into an activity. Give them something to do and focus on, something meaningful. If they are picking at their skin or fiddling with their clothes, give them a laundry basket of things to clothes. Ask the person to help you get this “work” done. Change the People (Caregiver Approach) Stay calm, and be patient. One of the gifts that Alzheimer's gives people is that they live in the present moment. On the other hand, it's hard for caregivers to do that because they're living in the future thinking about all the things that they need to do.  Be aware of the impact of your own emotions in the moment. Caregivers may get very upset that this person can't do today what they could do yesterday. Patience is essential because while that person's feelings remain intact, their ability to pick up on your feelings also remains intact. If you express feelings of being frustrated or mad, that energy is in the room and they are also going to pick up on that.  Demonstrate what you want them to do. Another part of the brain that remains intact is the ability to “mirror” us; meaning whatever emotional state we come into a room with, the person will mirror it back to us. This is also why mimicking a behavior you want the person to do works - they understand our non-verbal communication better than when we use words. Reassure the person with a calm voice and gentle touch.     Don’t use so many words. Don't argue or try to use logic; Alzheimer's affects memory, and the person may not remember he/she asked the question already.   Provide an answer. Give the person the answer that he or she is looking for, even if you have to repeat it several times. If the person with dementia is still able to read and comprehend, it may help to write it down and post it in a prominent location.    Accept the behavior, and work with it. If it isn't harmful, don't worry about it. Find ways to work with it. Go with what the person can or wants to do in the moment. Resistance is usually met with resistance. As caregivers, we often have our own agenda. Things we want and feel like we need to get done. Pushing our agenda on someone else is likely to be met with resistance. If we push harder, they resist harder. So if this happens in an interaction, stop pushing and it’s very likely the person with Alzheimer’s disease will stop resisting. Wait until another time and come back and try again. Flexibility is key for this one. Share your experience with others. Find your own support group, a group of people that you can talk to and share your experiences with. Learning from other people is going to be helpful. What worked today may not work tomorrow and this can be frustrating. Be sure you have the emotional support that you need. “Turn the action or behavior into an activity.” —  Melissa Batchelor, PhD, RN, FNP, FAAN  Change the Place (Environment) Use memory aids. If the person is calling you every day asking the same questions over and over again, try to use visual cues to offer reminders.  Using notes, clocks, calendars or photographs, if these items are still meaningful.  None of us can remember everything, so that might be another strategy that could help with a repetitive question. Manage Noise. Too much noise or activity can also raise a person’s level of anxiety. Sensory overload can increase their anxiety and end up with a behavior that they didn't really mean to get.  Some behaviors do have the same solution though. One patient that I cared for a long time ago had daily repetitive verbalizations. He would get started up in the afternoon and you could hear him all over the building. When he did this, all of the staff knew it was time to take him out for a cigarette. He calmed right down after he smoked, until the next time he wanted one. And while I don’t think smoking is a great idea, in this case, it was the lesser evil than giving him a medication that would have likely caused greater harm. If you’d like me to talk about another topic related to Alzheimer’s disease, send me a question on the “Contact Melissa” section of this website and I’ll get to it as soon as I can. Thanks for listening ~ and reading!  About Melissa: I earned my Bachelor of Science in Nursing (‘96) and Master of Science in Nursing (‘00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post-Master’s Certificate in Nursing Education from the Medical University of South Carolina College of Nursing (’11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health and Humanities. Find out more about her work at https://melissabphd.com/.

Dec 2020

13 min 29 sec

Bringing the Washington, DC Healthcare Policy Experience to Quinnipiac University “A critical part of that has to be understanding how policies develop and the implications that both national and state policies have on the ability to deliver high-quality care.”— Dr. Matthew O’Connor, Dean & Professor of Finance According to statistics, all Boomers will turn 65 by 2030. This will be about 20% of the American population, approximately 70 million Americans. It's estimated that we will need at least 3.5 million additional health care professionals and triple the number of direct care workers. It's going to create a crisis in staffing and health care.  Part One of ‘Bringing the Washington, DC Healthcare Policy Experience to Quinnipiac University’ The Institute of Medicine Landmark report for an aging America on building the healthcare workforce stated that unless action is taken immediately, the healthcare workforce will lack the capacity in both size and ability to meet the needs of older patients in the future. NAS calls it a crisis.  This is why the training of healthcare leaders, particularly in aging policy, is critical to developing good leadership and strategies that can help them understand how the organization needs to function in a very high-quality environment.  Another component is that they must understand what goes on in D.C. and how it impacts the delivery system. Such as how providers are reimbursed, how quality is measured, how money is appropriated for NIH research programs. And, it’s important to show appreciation towards the medical professionals and social workers who are “in the trenches”. They have a practical perspective on how things are being done. “There has to be an appreciation of the medical professionals, what the social workers bring to the table, and how they think that we need to work more as a team.” — Angela S. Mattie, Esq., MPH Therefore, given the aging demographic and the lack of providers to take care of these people, there is a need to train graduate students and practitioners on health policy and how things impact their business. As well as to show appreciation towards what the social workers are bringing to the table. When you think about health care organizations, there are two critical areas. There's the clinical care that's provided. That's the front and center. All clinical care is provided within an organizational framework. And those organizations have to function well. They have to be able to execute on tasks. And, then there is the management vs leadership. They have to be able to have good management policies and good quality control.  Part Two of ‘Bringing the Washington, DC Healthcare Policy Experience to Quinnipiac University’ According to Professor Mattie, there are four pillars of training: First:  We need an interdisciplinary approach to health care. We have a med school, a law school, a school of nursing, a health science program with multiple disciplines, the health care coverage in our school of communication, healthcare analytics, coverage in our College of Arts and Sciences, and an engineering school that's also interested in how they can contribute broadly in the area of health care.  Second: Healthcare leaders need business skills and business students need a deep understanding of healthcare specific to each discipline.  Third: COVID has shown us that we need to train healthcare providers to have crisis management skills. How to set up field hospitals, train staff and take care of patients and plan. This won’t be our own …leadership skills and soft skills like emotional intelligence. Fourth: And to teach students how federal and state policies impact our communities and our health.  And how to partner with those in the field to have access to the expertise in the field in order to do this. “Universities can contribute to training the next generation of healthcare leaders with an interdisciplinary focus.” —  Angela S. Mattie, Esq., MPH For any students interested, Quinnipiac University has an MBA program that allows a concentration in health care management, and they have a degree in organizational leadership that has a concentration in health care. Quinnipiac has a business analytics program that has health care analytics courses as well. We are experiencing phenomenal and very rapid changes in everything from artificial intelligence, machine learning, data analytics, and even wearable technologies that will impact healthcare. — Dr. Matthew O’Connor, Dean and Professor of Finance The role and future of technology are also critical areas that healthcare leaders will need to understand when they get out into practice.  Professor Mattie was a Robert Wood Johnson Health Policy Fellow for the US Senate Health, Education, Labor and Pension Committee in 2000-2001. So, what was different in this Fellowship with a placement in the House, and how did the pandemic impact the fellowship? Angela completed her RWJF Health Policy Fellowship during the 9/11 terrorist attacks - and during her Health and Aging Policy Fellowship, we have experienced our first pandemic. One of the key things that she worked on as a Fellow was patient safety legislation for good reasons.  Professor Mattie’s father was a victim of a patient safety event. She remained silent about her story despite many years of working with the health care community, thinking it might impact her relationships with others. And the moment she decided to step up and shared it recently, she saw the difference it made to many people’s lives to share her story. The importance of advocacy and telling your story can’t be underscored enough.  As a result, she met a lot of constituents over ground funding for various diseases. Angela remembers one particular group that came in from cystic fibrosis with the lobbyists and various people from the advocacy organizations. They also came in with two moms with the same case. One of the mothers brought a Russian stacking doll with her. Each one of the dolls were episodes that her poor daughter had gone through such as the cost of the episodes. Including hospital admission, 10 day stay, her ventilator, and medicine costs. This was a powerful visual to see.  On another note, The Health and Aging Policy Fellowship has greatly impacted Professor Mattie’s next career steps. She is truly honored and privileged to be a Quinnipiac University (QU) Albert Schweitzer Fellowship recipient this year, which allows her to continue her work. The institute was established to introduce Schweitzer's philosophy, a preference for life to a broader audience. What better way to do that than help bring policy and aging policy to our Quinnipiac community!  Together with Dr. O’Connor, they’re going to establish this health care policy immersion program with a focus on an interdisciplinary team of students and also looking toward individuals who have the ability to make a positive impact on health policy development. So, paying it forward and also developing those that might have an interest in engaging policy or policy in general.  Again, for any students interested, Quinnipiac University has an MBA program that allows a concentration in health care management, and they have a degree in organizational leadership that has a concentration in health care. Quinnipiac has a business analytics program that has health care analytics courses as well. About Dr. Matthew O’Connor Dr. Matthew O’Connor is Dean and Professor of Finance in the School of Business at Quinnipiac University. He has been with Quinnipiac since 1999, when he was appointed Assistant Professor of Finance. From 2005 to 2008, he served as Chair of the Finance Department. In 2008, he was appointed Interim Dean of the School of Business, and in 2009 he was appointed Dean. As Dean, Dr. O’Connor led the school’s efforts to expand its graduate programs, including launching the online MBA and online Masters programs in Business Analytics and Organizational Leadership.   Under his leadership, the business school stewarded the successful design, development, and launch of the School of Engineering. Conscious of the need to provide value to students, Dr. O’Connor also led efforts to develop accelerated dual-degree undergraduate to graduate programs, significantly reducing the time and cost of comprehensive higher education.   Dr. O’Connor is committed to the university’s teacher-scholar model. He launched and continues to teach the Finance program’s student managed portfolio course, which now has $3.0 million of assets under management. Additional teaching areas include undergraduate and graduate courses in Corporate Finance, Financial Modeling, Investments, and Portfolio Management. In 2005, Dr. O’Connor was honored with a Quinnipiac University Excellence in Teaching Award. In 2010, Dr. O’Connor was honored with the SIFE Most Supportive Dean of the Year Award. Dr. O’Connor has published in prestigious journals such as the Journal of Banking and Finance, the Journal of Financial and Quantitative Analysis, Corporate Finance, the Journal of Applied Business and Economics, the Financial Services Review, and the Financial Review.   Highly committed to professional service, Dr. O’Connor served two terms on the Initial Accreditation Committee for AACSB, the Association to Advance Collegiate Schools of Business, International. He also serves on the boards of United Methodist Homes, the Greater New Haven Chamber of Commerce, and Junior Achievement of Southwest New England. He is a Corporator for Ion Bank and a former Director at CEU.com, the Technology Investment Fund, and ReSET, the Social Enterprise Trust. Prior to joining Quinnipiac University, Dr. O’Connor worked as a Treasury Analyst for Rogers Corporation and an Actuarial Analyst for MassMutual Life Insurance, Co.   Angela S. Mattie, Esq., MPH   Angela Mattie, a professor of management in the School of Business and director of the long-term care and compliance certificate program. She also holds an appointment at the medical school at Quinnipiac University (QU).  At Quinnipiac, she created a corporate compliance certificate program, the first program accredited by the national association.  Ms. Mattie and her colleagues received the International Compliance Award for their contributions to healthcare compliance.   Angela completed the 2017 Bruce Bradley, Leapfrog fellowship designed for corporate professionals who want to take an active role in steering employees and their families to safer, higher-quality hospitals and health care systems.   In 2019-2020, she was named a Health & Aging Policy Fellow with a placement in Representative DeLauro’s Washington, DC office. Prof. Mattie serves on several boards, including Trinity Health of New England, where she chairs the Board’s quality & safety committee. She is also a member of St. Mary’s Hospital’s Quality Committee, Board Member of the CT Chapter of the American College of Healthcare Executives (ACHE) and serves as the faculty director/advisor for the Quinnipiac University ACHE student chapter. She is the 2012 recipient of the Distinguished Faculty/Advisor Award from CT ACHE and the 2013 Center of Excellence in Teaching Award from Quinnipiac University.   Prior to joining Quinnipiac, Angela was Vice-President, Performance Improvement for Sisters of Providence Health Care System (SPHS).  As a member of the executive team, she had oversight responsibilities for legal, quality, risk management, worker’s compensation, infection control, HIPAA privacy implementation, and corporate compliance.   In 2000-2001, Angela was selected for the competitive Robert Wood Johnson Health Policy Fellowship.  She served as a health policy fellow for the U.S. Senate Health, Education, Labor, and Pensions Committee.  During her Fellowship, she was on leave from Anthem, Inc. in the corporate office of medical policy.  In her role with Anthem, Inc., Ms. Mattie was responsible for designing risk-reduction strategies and project implementation for uniform medical policy for the corporation. Before joining Anthem, Inc., Ms. Mattie was Assistant Vice-President, Quality Improvement Services with The Connecticut Hospital Association (CHA). She had responsibility for a clinical research program that received state and national recognition.  She is frequently called upon by the media for views on healthcare issues and has numerous healthcare management publications and presentations at national conferences. Ms. Mattie received her Master’s Degree in Public Health (M.P.H.) with distinction from Yale University School of Medicine, Department of Epidemiology and Public Health, a Juris Doctorate (J.D.) at the University of Connecticut School Of Law, and an undergraduate degree, summa cum laude from Quinnipiac University. She is the proud mother of a MSW and still likes rock-n-roll music. About Melissa Batchelor, PhD, RN, FNP, FAAN I earned my Bachelor of Science in Nursing (‘96) and Master of Science in Nursing (‘00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post-Master’s Certificate in Nursing Education from the Medical University of South Carolina College of Nursing (’11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health and Humanities. Find out more about her work at https://melissabphd.com/

Dec 2020

34 min 13 sec

Role of Place in Healthy Aging with Ryan Frederick “This pandemic has been a great reminder that place matters a lot.”— Ryan Frederick, CEO of SmartLiving 360 Have you ever wondered why the long-term care housing industry segregated itself when there's so much benefit to having intergenerational housing? Have you ever thought about our older loved ones living in a better community to make their aging experience more comfortable?  Here are the important points covered in this episode: Ryan's focus on the intersection of place, including housing,  and healthy aging. How SmartLiving 360, a strategy consulting and a residential development company, is shifting the field of housing for older adults and long-term effects. Ryan's focus on creating inspired homes in walkable, intergenerational mixed-use urban and suburban areas. Mind shifting: aging as a solo sport to aging as a team sport. Part One of ‘Role of Place in Healthy Aging with Ryan Frederick’ America's solution to not living in a skilled nursing home is to move into an assisted living facility, but assisted living is segregated housing in most communities. Having been an operator of senior housing communities, some of the largest companies in the country, then also as an investor and a real estate developer, Ryan witnessed the impact that housing has on people in general. We're now seeing situations where different states aren't prepared, which shows that having a safe and comfortable place where older adults can stay is crucial. Some of the common questions people ask are: “Can we create jobs and better housing that doesn't have the same institutional feel of what we've done historically?” “Can we create environments where we don't necessarily have to have all the services bundled in, but instead bring things in when people need them?” “There's more that we can do now in non-medical settings to keep people healthy.” — Ryan Frederick, CEO of SmartLiving 360 Here's a simple way to look at things differently: if there's a way to create a better community for older adults, it's essential to recognize those things as a valuable antidote to loneliness and social isolation. They deserve a place where they can enjoy being socially and physically active. Part Two of ‘Role of Place in Healthy Aging with Ryan Frederick’ The more we can create a place where older adults can have greater options to choose from, we can have them thrive over a longer period of time because it’s not inevitable for them to live in a nursing home for ten years. Having choices that suit someone’s lifestyle makes it easier for them to remain socially active. It’s like investing in their overall well-being.  “Becoming disabled is not a normal part of aging. It's common because people become socially isolated.” —  Melissa Batchelor, PhD, RN-BC, FNP-BC, FGSA, FAAN What if we start changing things for the better? Why do we have so much age restriction, where older adults are taken away from their community? How can they find ways to have that intergenerational connection? This is where the vision of SmartLiving 360 becomes a game-changer for everybody, which is another way to maximize the use of advanced technology in our generation. Universal design benefits people of all ages. There may be multiple small changes, but they all add up. Also having a sense of community and connection matters too. Activities should be resident-driven - and in this sense of the term, those who live in intergenerational housing. Place can create surrogate relationships between the generations that are mutually beneficial.  Aging alone isn’t likely to be a successful venture. Ryan says we all need ot have an A-Team. We all need to have a team of people to support us, and ideally that will be reciprocal. Sense of purpose matters, getting out and moving, connecting with others socially, all of these things matter. Your built environment can make it easier to do all of these things, so it’s critical that we think through age-friendly, walkable housing options for people of all ages - so we can all thrive. Ryan’s new book is due for publication in the fall of 2021 - Home is Where the Health Is: A Guide to Choosing Place in the Age of Longevity.  Ryan Frederick, Founder & CEO, SmartLiving 360 Ryan is focused on the intersection of healthy aging and the role of place, including housing. SmartLiving 360 helps institutions and individuals thrive in the Age of Longevity by providing consulting services, real estate development services, and consumer content. Ryan publishes a monthly consumer blog at www.smartliving360.com and will release a consumer book, Home is Where the Health Is: A Guide to Place in the Age of Longevity, with Johns Hopkins University Press next fall.  Ryan is recognized as a national thought leader and innovator in the real estate development and healthcare services industries and is a keynote speaker, instructor, author, and blogger. His work and insights have been cited in Forbes, The Washington Post, and Environments for Aging, among other outlets. His real estate development in Rockville, MD, The Stories at Congressional Plaza, is an age-friendly apartment community that has attracted national attention. Mr. Frederick is a member of the National Advisory Board for the School of Nursing at Johns Hopkins University, a member of the AgingWell Hub, a collaborative of leading innovative providers in the field of aging led by Phillips, and has been appointed to the Advisory Council of the Bipartisan Policy Center Health and Housing Task Force. He is a 2018-2019 Encore Public Voices Fellow.  Mr. Frederick is a graduate of Princeton University and the Stanford Graduate School of Business. Mr. Frederick is a recent transplant to Austin with his wife and three kids, after living significant life chapters in Baltimore and San Francisco. Linkedin: https://www.linkedin.com/in/ryanefrederick/ About Melissa Batchelor, PhD, RN, FNP, FAAN  I earned my Bachelor of Science in Nursing (‘96) and Master of Science in Nursing (‘00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post-Master’s Certificate in Nursing Education from the Medical University of South Carolina College of Nursing (’11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health and Humanities. Find out more about her work at https://melissabphd.com/.

Dec 2020

21 min 52 sec

Towards an Age-Friendly World with Wendy Miller “As we get older, we use both sides of our brain, not in a compensatory way, but in a synthetic way.”— Wendy Miller, Ph.D. ATR-BC, LCPAT, REAT, LPC, BCPC Thank you for joining us for This is Getting Old: Moving Towards an Age-Friendly World podcast. This special series is sponsored by a 2020 George Washington (GW) University’s University Seminar Series award, Towards Age-Friendly, and is brought to you by MelissaBPhD in collaboration with GW’s Center for Aging, Health, and Humanities. It’s been proven that when people challenge their minds, have a sense of mastery and control, when their social engagement is increased, they not only do better, they feel better. In this episode, we are joined by Dr. Wendy Miller, author of Sky Above Clouds: Finding Our Way Through Creativity, Aging, and Illness. The key areas we covered in this episode:  Understanding the work of Wendy’s late husband, Dr. Gene Cohen. Understanding the term “creative aging.” How the arts and art-making are like “chocolate to the brain." The “Four S’s in Age-Friendly Creative Aging” and their importance. Part One of ‘Towards an Age-Friendly World with Dr. Wendy Miller’ An important piece of creativity, particularly as we get older, is legacy work, what we do with the memories and the archives of people we love. She felt a strong responsibility because Gene Cohen had many unpublished works, considering both of them are into creativity, health, and aging.  When does a creative aging start, and how do we come to understand creativity? The thing is, the word creativity stirs up everything. Some people would say, "Well, you're creative because you're an artist, but what about me?"  Our understanding of creativity with aging has been limited. As a result of the heavy legacy of negative myths and stereotypes about aging (ageism), all of which have denied or trivialized our creative capacity and the accomplishments that we have in the second half of our life. “Aging is not just about surviving. It's about growing in the face of diversity.” — Wendy Miller, Ph.D. ATR-BC, LCPAT, REAT, LPC, BCPC In 2001, Dr. Gene wrote the book: The Creative Age: Awakening Human Potential in the Second Half of Life. It was the first book to articulate this new paradigm about looking not just at the problems of aging, but at this emerging field of creative aging. C=ME2 is Creativity = Mass of Knowledge + Experience2 His book documents discoveries in neuroscience that radically challenge these conventional assumptions about aging, and aging is really the best example of how the whole is greater than the sum of its parts.  There are built-in developmental drives that push us toward creative expression, and they push us towards psychological growth throughout our life cycle. His research doesn't just respond to aging. It's trying to shape aging.  Part Two of ‘Towards an Age-Friendly World with Wendy Miller’ Our brain is continually sculpting itself. The aging brain isn't running out of gas, it’s moving into all-wheel-drive. This post-formal thinking transforms our life. It transforms our life experience into what we commonly call wisdom. The arts are like “chocolate to the brain”. Creativity is built into the human species. The arts can be singing, dancing, cooking, gardening and also giving back to the community and volunteering.  But creativity can also be designing a new lecture, a new way to teach someone how to do something, or learning a new skill that lets you do either of those things in an innovative way.  What it boils down to is that as we get older, we use both sides of our brain not in a compensatory way but in a synthetic way. The more you use it, the more you are protected against Alzheimer's disease. COVID has challenged everyone to be creative with how we connect with each other using technology. “Creativity encourages these evolving strengths. They don't just happen on their own.” —  Wendy Miller, Ph.D. ATR-BC, LCPAT, REAT, LPC, BCPC How would you feel if more older adults get involved in creative artworks? Aging is not just about surviving. It’s about growing meaning in the face of adversity. Creativity optimizes problem-solving and affects interpersonal connections that leads us into our strengths.  What makes This Is Getting Old podcast exciting is that it includes a focus on the humanities. This is a case for qualitative medicine - use of narrative, listening, writing, case histories, keen observation, and empathy, and imagination - to look at strength and satisfactions because they are the essence of human strength and resilience. Many people in the world do not have the right image of aging. Intergenerational creative activities and interactions have the ability to change that. As a society,  if we only look at the Signs and Symptoms of aging, we will miss the Strengths and Satisfaction with aging. It matters because creativity encourages these strengths that lead to increased satisfaction with our lives as we age.  Older adults have life stories that benefit younger adults, stories of resilience and overcoming hardship. Media outlets have reported many older adults are actually weathering COVID better than younger generations. Many older adults also are still experiencing higher levels of emotional well-being than younger adults. We can all learn from this group of Americans that are often age-segregated, and we need to find intergenerational ways to do just that - to benefit both older AND younger adults. Being age-friendly means things are friendly for everyone. Wendy ends the interview with these words: "The creative faculty is what draws us to life, calls forth our love, our resilience, our strength, and our capacity to choose not only life itself but to choose what enlivens us. Sky above clouds opens us not only to potential, but to the essential.”  Wendy Miller Bio:  Wendy Miller, Ph.D. ATR-BC, LCPAT, REAT, LPC, BCPC is a writer, sculptor, educator, and mental health provider in expressive arts therapy. She taught for over fifteen years in various universities throughout the country, including John F Kennedy University, San Francisco State University, Southwestern College, Lesley College, California Institute of Integral Studies, and The George Washington University. She is the co-founder of Create Therapy Institute in Kensington, MD, which offers clinical services in arts-based psychotherapy and training in the expressive arts. She is a founding member, and first elected (past) executive co-chair of the International Expressive Arts Therapy Association, where she continues to be on their Advisory Council. She is also an Advisory Board Member of the Peter Alfond Prevention & Healthy Living Center at MaineGeneral Health. She continues the legacy of her late husband’s work, pioneer of creative aging, Gene Cohen, and his Washington DC Center on Aging, where she works on projects in intergenerational communication.   Miller’s skills take her into the worlds of fine art, writing, psychology, expressive arts therapy and mind-body medicine.  She has published on medical illness and the arts as complementary medicine, the use of sand tray therapy with internationally adopted children, experiential approaches to supervision in expressive arts therapy, and on the cultural responsibility of the arts in therapy. She continues to research the relationships among the arts, creativity and health, particularly in her book which draws from the writing she and her late husband, Gene Cohen did together, entitled: Sky Above Clouds: Finding our way through creativity, aging and illness (Oxford University Press, 2016). Purchase the Sky Above Clouds: Finding Our Way through Creativity, Aging, and Illness Book: https://amzn.to/3l0tCvC or visit https://www.sky-above-clouds.com/ The Creative Age is https://www.amazon.com/Creative-Age-Awakening-Potential-Second/dp/0380800713 or  https://www.amazon.com/Creative-Age-Awakening-Potential-Second/dp/0380800713/ref=sr_1_2?dchild=1&keywords=The+Creative+age&qid=1606244088&sr=8-2   The finding key for Gene Cohen’s archived works at U Mass Special Collections and University Archives is:is: http://findingaids.library.umass.edu/ead/mums1079  GET IN TOUCH WITH WENDY MILLER: Facebook: https://www.facebook.com/profile.php?id=708580027   Instagram: @WendMiller11   FB page: https://www.facebook.com/SkyAboveClouds Oxford Academic Page: https://www.facebook.com/OUPAcademic/ Professional Organizations: IEATA https://www.facebook.com/IEATA.non.profit/ AATA https://www.facebook.com/TheAmericanArtTherapyAssociation/ PATA: https://www.facebook.com/potomacarttherapy/ About Melissa Batchelor, PhD, RN, FNP, FAAN  I earned my Bachelor of Science in Nursing (‘96) and Master of Science in Nursing (‘00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post-Master’s Certificate in Nursing Education from the Medical University of South Carolina College of Nursing (’11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health and Humanities. Find out more about her work at https://melissabphd.com/.

Dec 2020

25 min 19 sec