Aging Successfully Spring 2016

Spring 2016 Vol. XXV, No. 1Federal $2.5 Million Grant to SLU Aims toTransform Geriatric CareSLU-Led Program Will Train Primary Care ProvidersBy Nancy Solomon, Saint Louis University Medical Center Communications Director Funded by a three-year, $2.5 students in geriatric medicine,million grant from the U.S. De- geriatric psychiatry, nursing,partment of Health and Human social work, physical therapy, oc-Services, faculty with the Gate- cupational therapy and interpro-way Geriatric Education Center fessional education.(GEC) are leading an initiative toimprove the health of older Mis- “Providing the care our oldersourians by training primary care adults deserve is a huge challengehealth providers in geriatrics. that requires the commitment of many different professionals The GEC is working with from many institutions,” saidtwo other universities, a rural John Morley, M.B., B.Ch., Chair,hospital, a hospital system, two Division of Geriatric Medicine atpublic community health centers, Saint Louis University and Marlaa senior center and a health non- Berg-Weger Ph.D, LCSW, andprofit to join in an ambitious plan Executive Director of the Gate-that addresses the significant way GEC, who is the project’sshortage in underserved urban Co-Director.and rural areas of health careprofessionals who know how to “As our state has significantcare for older adults. The project shortages of primary care healthwill involve professionals and professionals and rapidly increas- ing numbers of older adults, we (continued on page 4)

SLU Geriatricians Recognized as Best Doctors 2015 Seven members of the Geriatrics Division medical faculty have been rec- ognized by St. Louis Magazine as Best Doctors of 2015. This designation is based on the annual “Best Doctors in America” database that analyzes over one million peer evaluations. Geriatricians include:1 Transforming Dr. John E. Morley Geriatric Care Dr. Dulce Cruz-Oliver Dr. Julie A. Gammack2 Best Doctors in St. Louis Dr. Joseph H. Flaherty3 Editorial6 Cognitive Stimulation Therapy8 Interprofessional Education10 Rapid Geriatric Assessment12 Rapid Geriatric Assessment Screening Tool14 News at SLU15 A Pep Talk for Geriatricians17 Who’s Hearing Their Voices?20 Geriatric Leadership Scholars Announced21 Visiting Interna- tional Scholars23 Continuing Education Opportunities Dr. Gerald Mahon Dr. Milta O. Little Dr. Frederick Yap2 Aging Successfully, Vol. XXV, No. 1 email: [email protected] Questions? FAX: 314-771-8575

EDITORIALIn 1996, there were 8,424 geriatricians in the United States, whereastoday, there are fewer than 7,50 0. In 2000, there were 4.7geriatricians for every 10,000 persons in the U.S. who were 75 yearsand over. This number is expected to shrink to 1.5 per 10,000 by 2050.Clearly, this is a catastrophe of gigantic proportions for the future ofour aging population.WHERE HAVE ALL THE GERIATRICIANS GONE? There is no question that c i a n s — $18 4 , 0 0 0 / agitate the systemgeriatricians are key to assess-ing, diagnosing, and treating year compared to to make the geri-the more difficult to manageconditions experienced by $498,127 for a ra- atric specializationolder adults. Geriatriciansalso teach medical students, diologist. Secondly, a more desirableresidents and practicing phy-sicians how to care for older geriatricians are af- career option forpatients and strategies for or-ganizing health care systems forded less respect future generationsthat are focused on seniors.Those members of the baby by their colleagues of physicians. Inboom generation are rightlygoing to expect higher quality who believe that part, this effortcare than has been given in thepast to older persons. anyone can provide will require that we The reasons for the dearth medical care for old- demand better payof geriatricians are multifacto-rial. First, geriatricians earn er persons. My col- for geriatricians,approximately half the sal-ary of other specialist physi- league, Dr. Angela John E. Morley, MB, BCh but it will also re-Questions? FAX: 314-771-8575 Sanford, reflects on quire a major pub- this issue in her poignant “Pep lic education campaign Talk for Geriatricians” (see p. with our general society 15). Finally, many graduating as well as the physician medical schools do not view and health care commu- geriatric care as being as excit- nities regarding the key role ing as other areas of medicine. that geriatricians play in the It is time that all of us who role of the older adults. care about the future of ag- ing baby boomers to begin to email: [email protected] Aging Successfully, Vol. XXV, No. 1 3

Transforming Geriatric Care the state’s population living in rural areas and only 25(continued from page 1) percent of physicians prac- ticing in these areas, themust act now to train pri- need for a well-trained geri-mary care professionals atric workforce is at a crisishow to conduct screenings, point.”assessments and inter-ventions to improve the Further, because thehealth of older adults. I’m number of geriatric practi-energized that so many tioners is insufficient to careorganizations and people for our growing number ofare joining SLU in bring- older adults, developing ge-ing life to a plan that will riatric evaluation teams isimprove the quality of life essential for the health andfor aging Missourians,” quality of life of our agingsaid Morley, who also is a population.SLUCare Physician Groupgeriatrician. Tackling from Many Angles The project, which isLeading a Team areas: urban north St. Louis city and Collaborative partners county and rural Perry County and called the Gateway Geri- an eight county region in northeast atric Education Center Workforceinclude A. T. Still Univer- Missouri, where the impact of the Enhancement Program, attacks thesity Osteopathic Medi- shortage of health care providers who problem on multiple fronts by:cal School/Missouri Area Health understand the special needs of geri-Education Centers in Kirksville and atric patients is amplified. ••Educating 1,100 health carePerry County Memorial Hospital. students and providers on aUniversity and community partners Graying of Missouri team-approach that bringsare Washington University in St. Older adults comprise a larger together professionals fromLouis, SSM Health, Myrtle Hilliard multiple health disciplinesDavis and John C. Murphy Health proportion of Missouri’s population to best care for older adultsCenters, Northside Youth and Senior than in the greater United States. InServices and the St. Louis Alzheim- 2011, 14.2 percent of Missourians Health professions students ander’s Association. were older adults, compared to 13 those who provide care at the senior percent of U.S. residents. By 2030, center, health centers and rural phy- The grant to SLU is funded the percentage of older Missourians sician practices will be trained tothrough the Health Resources and is expected to increase to 21 percent, work in interprofessional teams asServices Administration (HRSA), compared to 19 percent in the U.S. they conduct physical and cognitivethe main federal agency in the De- screenings, assessments, and pro-partment of Health and Human Ser- “To keep pace with the growth vide interventions. Students and carevices charged with improving health of the older adult population who providers will learn to use screen-care for those who are uninsured, often have multiple health problems ing tools, including many created and complex conditions that require at Saint Louis University, to detect isolated, or medically vulnerable. more medical care, the number of cognitive impairment, frailty and Slightly more than a quar- primary care providers needs to caregiver well-being. They also will increase by 34 percent,” said Marla learn to deliver cognitive stimulation ter of the institutions that Berg-Weger, Ph.D., LCSW, profes- therapy, which is a non-pharmaceu- submitted applications for sor of social work at SLU and co- tical intervention for persons with de- federal funding received it. project director. “With 40 percent of mentia that stimulates socialization, The project is one of 44 GeriatricWorkforce Enhancement Programs Questions? FAX: 314-771-8575in the U.S. and one of two in HRSAregion VII, which includes Missouri,Iowa, Kansas, and Nebraska. The initiative targets underserved4 Aging Successfully, Vol. XXV, No. 1 email: [email protected]

Transforming Geriatric Care •• Annually designating three faculty members(continued from page 4) from universities in Missouri annually asconversation and memory; a simple Geriatric Leadershipexercise program to restore muscular Scholars who will re-function; and support and resource ceive specialized train-information to caregivers of those ing and mentoringwho have dementia. Scholars will receive Training sites for the first yearof the grant include Myrtle Hilliard salary support and travelDavis Comprehensive Health Center,Northside Youth and Senior Services, funds to attend a nationaland SLU’s Health Resource Center, afree clinic run by SLU medical stu- geriatric conference;dents in north St. Louis, John C. Mur-phy Health Center in north St. Louis complete a capstoneCounty, A.T. Still University, TrumanState University and Missouri Area project that focuses onHealth Education Center in northeast research, patient care or Project Co-Directors Dr. Morley and Dr. Berg-WegerMissouri, and Perry County Memo-rial Hospital in Perry County. Train- education; and work with students The Geriatric Leadership Schol-ing sites will be expanded to include in the clinical training program. ars and St. Louis Alzheimer’s Asso-SSM Health locations in St. Louis,Mexico, Audrain and Maryville the •• Training 5,000 patients, fam- ciation will partner to create a lecturesubsequent two years. ily members and care pro- series on general geriatric issues, de- viders to improve quality of mentia, mild cognitive impairment, life by becoming healthier and caregiver support to be delivered (continued on page 22) SERVICES Services of the Division of Geriatric Medicine include clinics in the following areas: AVAILABLE ONLINE! • Aging and Developmental Disabilities • Bone Metabolism • Falls: Assessment/Prevention • • Geriatric Assessment • • Geriatric Diabetes • • Medication Reduction • • Menopause • • Nutrition • Podiatry • • Rheumatology • • Sexual Dysfunction • • Urinary Incontinence •S The latest edition of this ever-useful pocket-sized CallL book, chock-full to the brim with screening tools 314-977-6055U (at Saint Louis University)G and mnemonics, is available on our website!EM or 314-966-9313S Visit aging.slu.edu to access this tool. To order hard copies, email your request to [email protected]. (at Des Peres Hospital)Questions? FAX: 314-771-8575 email: [email protected] Aging Successfully, Vol. XXV, No. 1 5

COGNITIVE STIMULATION THERAPY:Making a Difference for People with Mild toModerate DementiaBy Julia Henderson-Kalb, MS OTR/L, Marla Berg-Weger, PhD, LCSW, Susan Tebb, PhD, MSW, RYT-500, Max Zubatsky, PhD, LMFT,Janice Lundy, BSW, MA, MHA, Debbie Hayden, RN, BSN, OTR/L, & Daniel Stewart, MSGWhen someone dem- com/. The manuals onstrates signs of also include guiding dementia or Al- principles that shouldzheimer’s disease, there can be be incorporated intoa sense of impending doom for each session (Tableboth the individual and his or 1). The GEC Train-her loved ones. As a chronic, the-Trainer toolkitprogressive issue, dementia provides informationcan lead to decreased cogni- on forming groups,tion, decreased social stimula- selecting co-facilita-tion, and increased behavioral tors, managing groupissues. Individuals diagnosed members’ behaviors,with dementia and their care- Michele Sakamoto (center), who received her MSW from SLU in 2015, guides adjusting sessionsgivers might feel helpless. patients in chair yoga, a gentle type of yoga that improves strength, flexibility to be culturally ap-Medications are available to and mental acuity. Photo by Kristina Roselle, MSW. propriate, and otherslow the progression of the helpful ideas. Whendisease. However, some people are is well-known and well-used in the used together, providers can develop ahesitant to try them or are looking UK, its benefits are just beginning to CST program.for other non-pharmacologic thera- become apparent here in the US.pies to complement their medication CST-related research has shownregimen. As healthcare providers for At the GEC at Saint Louis Uni- that people who participate in CSTolder adults, we need to have a work- versity, an interprofessional group of often see improved cognition scores,ing knowledge of the options avail- faculty, practitioners, and students improved self-measured quality ofable to persons with these diagnoses. have collaborated to create a CST life ratings, decreased levels of de- Train-the-Trainer toolkit and train- pression, and improved language Cognitive Stimulation Therapy ing session for healthcare profes- skills. The standard CST sessions(CST) is an evidence-based, non- sionals to learn more about CST. are held twice a week for sevenpharmacologic individual and group Our goal is to provide information weeks and last 45 minutes to anintervention for persons with mild and inspire healthcare students and hour. Groups ideally consist of fiveto moderate dementia. Developed in providers to consider the possibility to eight people with two co-leaders,the United Kingdom by a team led by of implementing a CST program in although the size of the groups can their own programs and facilities. vary based on members’ functional Drs. Aimee Spector and Martin status. The groups actively engage Orrell, CST was created by There are three types of CST: members through organized, theme- combining the most effective Standard CST, Maintenance CST based group activities. Structure is aspects of several non-phar- (MCST), and Individual CST important to the success of CST, and (iCST). The creators of CST have each group session should flow in macologic interventions and is published manuals that guide fa- the same basic order.based in reality orientation. CST is cilitators through the sessions forthe only non-pharmacologic treat- all three types of CST. To learn Sessions begin with introductionsment endorsed by the UK Govern- about the origins of CST and obtain (of individual members, the group inment National Institute for Health information on training and manu- general, the day and weather, and anyand Care Excellence (NICE), regard- als, visit http://www.cstdementia.less of drug regimen. Although CST6 Aging Successfully, Vol. XXV, No. 1 email: [email protected] Questions? FAX: 314-771-8575

Cognitive Stimulation Therapyimportant events that have occurred times per week the groups meet, is scores improved. Finally, individualssince the last session). The group then the group cohesion. As the standard with dementia and their care partnerssings the group theme song, which seven- week sessions end, some value the mental stimulation that iCSTis chosen by group members during members may want to carry on into provided. Individual sessions are heldthe initial session. This activity pro- maintenance groups while some may three times per week for 20 to 30motes group cohesion and a sense of not. If a program has standard groups minutes at a time. The iCST manualstructure. An article from a local or starting and ending every seven provides for 25 weeks of iCST, or 75national news source is then distrib- weeks, maintenance groups will have separate sessions. As with the otheruted to members and discussed. Facil- new members entering at different in- forms of CST, each session shoulditators can invite the group members tervals, which may change the group follow a similar structure. Begin withto provide opinions about the current dynamics. Leaders must monitor warming up body movements, music,event and compare the issue/event to group size and determine members and a discussion of the weather ora past memory. Following the article who no longer benefit from CST. current events. This is followed bydiscussion, the main group activity Individual CST (iCST) is de- current events, refreshment, and ais completed as it is outlined in the signed for individuals who may not main activity, adapted as needed.CST manuals. Topics vary each week be comfortable with or are no longer All types of cognitive stimulationand have a lot of room for creativity appropriate for a group setting. iCST therapy have positive effects on an in-and adaptation. The group then ends is meant to be provided by a care dividual with dementia. This form ofwith a time of closure, which includes partner who has regular contact with non-pharmacologic treatment can bereviewing that session and discussing the person with dementia, often times a cost-effective alternative to main-plans for the next session. a spouse or adult child of the individ- taining and improving cognition,After the initial seven-week ses- ual or a professional caregiver. While quality of life, and socialization/lan-sion, maintenance (MCST) groups cognitive function and quality of life guage skills while decreasing depres-can be provided. MCST research has outcomes have not been shown to be sion. These improvements not onlydemonstrated that, after six months, significantly improved with iCST, affect the individual with dementia,participants’ self-rated quality of life individuals with dementia report the but also people who provide care tomeasures were higher than those relationship with their care partners the individual. Use of the manualswho did not participate in the groups. improved with iCST sessions. Care- and the GEC Train-the-Trainer tool-When persons with dementia partic- givers’ self-reported quality of life kit can assist any facility or programipate in MCST after in beginning a new CSTcompleting standard Table 1. Guiding Principles of Cognitive Stimulation Therapy program. Videos and onlineCST, their cognition 1. Mental Stimulation: Get people’s minds active and engaged training modules are nowcontinues to improve 2. Encourage new ideas, thoughts, and associations available on the GEC websiteslightly while their 3. Use orientation sensitively and implicitly at http://aging.slu.edu.counterparts who 4. Focus on opinions rather than facts R esou rcesdo not continue with 5. Use reminiscence as an aid to the here-and-nowmaintenance tend to 6. Provide triggers to aid recall: Using all five senses is encouraged D’Amico F, et al. Maintenance cogni-decline. The sessions 7. Continuity and Consistency is necessary between sessions* tive stimulation therapy: An economicare usually held once 8. Focus on implicit (rather than explicit) learning* evaluation within a randomized con-a week for approxi- 9. Stimulate language: Encourage group members in language use trolled trial. J American Medicalmately the same length 10. Stimulate executive functioning: Encourage “mental organization” Directors Association. 2014: 16(1), p.of time as the original 11. Person Centerdness: Treat people as individuals 63-70.sessions with a similar 12. Respect: Allow differences and avoid exposing people’s difficulties*format: introductions, 13. Involvement: encourage individual contributions* Orrell M, et al. A pilot study examin-theme song, current 14. Inclusion of all opinions* ing the effectiveness of maintenanceevent, group activ- 15. Choice: Group members help shape the group CST (MCST) for people with demen-ity, closure. What can 16. Fun! tia. International Journal of Geriatricvary from the stan- 17. Maximize potential using the “Just Right” challenge Psychiatry, 2005: 20, p. 446-451. 18. Build/strengthen relationships between group members and leaders Woods B, et al. Improved quality of life and cognitive stimulation therapy in dementia. Aging & Mental Health. 2006: 10(3), p. 219-226.dard CST, besides the *Standard CST and MCST principle only Aging Successfully, Vol. XXV, No. 1 7Questions? FAX: 314-771-8575 email: [email protected]

Interprofessional EducationBy Milta O. Little, D.O., and Helen Lach, Ph.D., RN, CNL, FGSA, FAANI nterprofessional health education has come to collaboration. Last, emphasize tors Dr. Helen Lach and Dr. the forefront of geriatric the role of reflection and team Milta Little have been work- facilitation. Reflection and ing to integrate the Rapidmedicine and Saint Louis Uni- de-brief should take place fre- Geriatric Assessment (RGA) into the curriculum in health science class- rooms across the Saint Louis University cam- pus, including social work, occupational therapy, physical ther- apy, nursing, medi- cine, medical family therapy, and commu- nication sciences and disorders. Students trained to perform the RGA have been able toPictured above: Students and faculty who participated in geriatric case competition participate in commu-versity is emerging as a leader quently and should be part of nity screenings across the St.in interprofessional geriatric one’s daily work life. Louis region.education. In order to ade- As part of the Geriatricquately create an environment Workforceof engaging interprofessional E n h a n c e -education, five main issues are ment Pro-being addressed. The first is g r a m a tpositive professional role iden- Saint Louistification of oneself and others. University,Second, identify and address several inter-hierarchical roles (both posi- professionaltive and negative). Third, g e r i a t r i c sprovide adequate incen- e duc at iontives for interprofes- opportuni-sional collaboration and t i e s h a v eacknowledgment of team been devel-members’ strengths and suc- oped to ad-cesses. Fourth, measure team dress thosefunction and outcomes in or- five issues. Competition winners (l to r): Danielle Thomas (Department of Family & Community Medicine, Medical Family Therapy Program), Colin Gallagherder to improve teamwork and Coordina- (School of Medicine), Tara Dauer (School of Nursing), and Kylee Sachtleben (Department of Communication Sciences and Disorders).8 Aging Successfully, Vol. XXV, No. 1 email: [email protected] Questions? FAX: 314-771-8575

Interprofessional Education Students from across the opportunity to really dig into use it in their future roles tohealth professions also partici- a case from so many perspec- become change agents andpated in the first annual “Ge- tives.” Another found the com- improve care for older adults.”riatric Case Competition” in petition “a safe environment They anticipate the competi-February 2016. Nine teams – to learn about other profes- tion will be an annual event,each with students from mul- sionals and learn how to work and is being held in the Falltiple disciplines were charged on a team.” Another student 2016 semester on Thursday,with becoming an interpro- stated: “I really enjoyed the October 27, 2016. For morefessional team and developing case competition. I thought it information on the case com-a plan of care for a geriatric was a great opportunity to be petition, email [email protected] based on a standard- exposed to other professions.”ized case. Students met over To build on the trainingone month and had access to Organizers Dr. Milta Lit- and work with students acrossa faculty mentor. Each team tle and Dr. Helen Lach were the University, an Interpro-made a formal presentation impressed with the quality fessional Geriatric Interestof their plan, and they were of the student’s work. “These Group has been started withrated on the quality of their students had a range of expe- a kickoff event Marchplan and interprofessional riences and knowledge and 29th for Careers in Ag-collaboration. Winners were were creative and resourceful ing Week. Students hadannounced at a reception to in addressing this patient’s the opportunity to hearcongratulate all the students problems” reports Lach. Little a lecture by Dr. Little onon their exceptional work. further noted “this is what Successful Aging and engage we want our students to do – in “speed mentoring” with ge- The competition was mod- take this geriatric experience riatric professionals.eled after a similar program at and think about how they canA. T. Still University, a part-ner in the Geriatric Work- email: [email protected] Aging Successfully, Vol. XXV, No. 1 9force Enhancement Programgrant from the Health Re-sources Services Administration(HRSA). Student professionsincluded medicine, nursing,physical therapy, communica-tion sciences and disorders,medical family therapy, socialwork, and public health. Students enjoyed the chal-lenge and opportunity to workwith peers from other profes-sions. One student enjoyed “theQuestions? FAX: 314-771-8575

The Rapid Geriatric Assessment At Saint Louis University, we If the associated algorithm is frailty (FRAIL) screen2,3,4,5 andhave developed the Rapid Geri- followed within these screening the sarcopenia measure (SARC-atric Assessment (RGA).1 The measures, the majority of persons F) have been validated on fourpurpose of the RGA is to allow with depression, sleep apnea, continents6,7 while the nutritionprimary care physicians to do weight loss, polypharmacy, inap- assessment (SNAQ) has beensimple case-finding for the pres- propriate drug use, and endocrine studied and validated on threeence of geriatric syndromes in disorders (e.g., hypothyroidism and continents .8,9,10 The Rapid Cog-older persons. The RGA screens vitamin B12 deficiency) can be iden- nitive Screen (RCS) is derivedfor frailty, sarcopenia (muscle tified. Figure 1 provides additional from the Saint Louis Universityweakness), anorexia, and cog- information on the algorithm. Mental Status (SLUMS) exami-nitive dysfunction. The RGA is nation and is available in 30 lan-presented in its entirety in the The simple screens that are guages11,12 which are available atcenterfold of this newsletter. used have been well validated http://aging.slu.edu. psychometrically. Both theFigure 1. Algorithm for Management of Frailty10 Aging Successfully, Vol. XXV, No. 1 email: [email protected] Questions? FAX: 314-771-8575

The Rapid Geriatric Assessment In addition to assessing the monic for treatable causes of the RGA please visit the GECfour areas noted here, the RGA weight loss. These informational website and view the video de-includes an item to determine if materials are available in their picting Dr. Milta Little admin-the older adult has completed an entirety in this newsletter. istering the RGA to an olderadvance directive to guide future patient. For questions or infor-and end-of-life care. Advance Utilizing our Geriatrics mation on screening opportu-directives are a key to appropri- Workforce Enhancement Pro- nities please send an email to gram (GWEP) grant, faculty are [email protected] health care in persons of allages, and need to be obtained integrating the RGA into the clin- Referenceswhile the person still has the ical services provided by Saint 1 Morley JE, et al. Rapid Geriatric Assessment.capacity to be involved in their Louis University, Perry County J Am Med Dir Assoc 2015 Oct 1;16(10):808-12.own decisions. Memorial Hospital, Northside 2 Malmstrom TK, et al. A comparison of Youth and Senior Services and four frailty models. J Am Geriatr Soc 2014 Here at Saint Louis Uni- two community health centers— Apr;62(4):721-6.versity, as part of the current Myrtle Hilliard Davis Health 3 Woo J, et al. Comparison of frailty indicatorsGeriatric Workforce Enhance- Care Center in North St. Louis based on clinical phenotype and the multiplement Program (GWEP), we have and the St. Louis County Health deficit approach in predicting mortality anddeveloped a computer-assisted Centers in North St. Louis Coun- physical limitation. J Am Geriatr Soc 2012management system for primary ty. The map that accompanies Aug;60(8):1478-86.care health professionals to use this article provides an overview 4 Woo J, et al. Frailty Screening in the Com-in making appropriate diagnostic of the geographic areas being munity Using the FRAIL Scale. J Am Medand treatment decisions. In addi- served in the St. Louis area. Uti- Dir Assoc 2015 May 1:16(5):412-9.tion to making the RGA available lizing GWEP faculty, staff, and 5 Theou O, et al. Identifying common charac-in paper and electronic formats, health professions students, we teristics of frailty across seven scales. J Amwe have developed health litera- are also providing screening in Geriatr Soc 2014 May 62(5):901-6.cy appropriate patient handouts the St. Louis community. 6 Woo J, et al. Validating the SARC-F: awhich stress lifestyle changes suitable community screening tool forsuch as exercise and high protein We are very excited at our sarcopenia? J Am Med Dir Assoc 2014diet for frailty and sarcopenia. success utilizing the RGA to al- Sep;15(9):630-4.Patient materials are also provid- low primary care health profes- 7 Cao L, et al. A pilot study of the SARC-Fed on issues related to exercise, sionals to improve outcomes for scale on screening sarcopenia and physicalmental stimulation, and a Medi- older persons in Missouri. The disability in the Chinese older people. J Nutrterranean diet with extra virgin RGA can be used as part of the Health Aging 2014 Mar;18(3):277-83.olive oil (polyphenols) for mild Medicare Annual Wellness Visit 8 Wilson MM, et al. Appetite assessment:cognitive impairment. GWEP (G0439) along with a depression simple appetite questionnaire predictsfaculty, staff, and students pro- screen (SLU “AM SAD” Tool), weight loss in community-dwelling adultsvide this assessment protocol to immunizations, listing of medi- and nursing home residents. Am J Clin Nutrphysicians of those persons who cal conditions, female history, 2005;82(5):1074-81.screened positive on the SNAQ, listing of medications and aller- 9 Rolland Y, et al. Screening older people atthe MEALS-on-WHEELS mne- gies, vital signs and weight. risk of malnutrition or malnourished using the Simplified Nutritional Appetite Ques-Questions? FAX: 314-771-8575 For more information about tionnaire (SNAQ): a comparison with the Mini-Nutritional Assessment (MNA) tool. J Am Med Dir Assoc 2012 Jan;13(1)31-4. 10 Reliability and validity of the Japanese version of the simplified nutritional appetite questionnaire in community-dwelling older adults. Geriatr Gerontol Int 2015 Dec;15(12):1264-9. 11 Malmstrom TK, et al. The Rapid Cognitive Screen (RCS): A Point- of-Care Screening for Dementia and Mild Cognitive Impairment. J Nutr Health Aging 2015 Aug;19(7):741-4. 12 Cummings-Vaughn LA, et al. Veterans Affairs Saint Louis University Mental Status examination compared with the Montreal Cognitive Assessment and the Short Test of Mental Status. J Am Geriatr Soc 2014 Jul;62(7):1341-6. email: [email protected] Aging Successfully, Vol. XXV, No. 1 11

Rapid GSearinit aLoturi There is no copyright on these screening tools, and they may be incorpora ID#:______________________ Sex: _________ Ethnicity (circle): African/Am AsianThe Simple “FRAIL” Questionnaire - Screening Tool Scoring: 3 or greater = frailty; 1 or 2 = prefrail F atigue: Are you fatigued? R esistance: Cannot walk up one flight of stairs? From Morley JE, Vellas B, Abellan van Kan G, Aerobic: Cannot walk one block? et al. J Am Med Dir Assoc 2013;14:392-397. I llnesses: Do you have more than 5 illnesses? L oss of weight: Have you lost more than 5% of your weight in the last 6 months?SNAQ - Simplified Nutritional Assessment QuestionnaireMy appetite is Food tastes Normally I eat a. very poor a. very bad a. Less than one meal a day b. poor b. bad b. One meal a day c. average c. average c. Two meals a day d. good d. good d. Three meals a day e. very good e. very good e. More than three meals a dayWhen I eat Scoring: a=1, b=2, c=3, d=4, e=5 a. I feel full after eating only a few mouthfuls A score of <14 indicates significant b. I feel full after eating about a third of a meal risk of at least 5% weight loss within c. I feel full after eating over half a meal 6 months. d. I feel full after eating most of the meal e. I hardly ever feel full From Wilson, et al. Am J Clin Nutr 2005;82:1074-81.SLU “AM SAD” Tool (Validated Geriatric Depression Tool)**AM SAD Question Frequency (Points) Points Scored A Within the past 2 weeks, how many times have you Never One day More than(Appetite) experienced unexplained change in appetite? one day (0) (1) (2)M(Mood) Within the past 2 weeks, how many times have Never One day More thanS(Sleep) you experienced unexplained lowered mood on (0) (1) one day a day to day basis? (2) Within the past 2 weeks, how many times have you experienced unexplained disturbed sleep? Never One day More than (0) (1) one day (2) A Within the past 2 weeks, how many times have you Never One day More than experienced less energy or not being interested in (0) (1) one day(Activity & performing your usual daily activities? energy) (2) D Within the past 2 weeks, how many times have you Never One day More than (0) (1) one day (Death or experienced feelings of worthlessness or guilt orworthlessness) that your life is not worth living? (2)Total Points _____/10 Total points Scoring 0-2 No depression** Cha kkam para mbi l B, e t al. D eve lopm ent o f a B rief V alid ated Geri atric Dep ressio n 3-5 Mild depressionSc reen ing T ool: The S LU “A M SA D.” Am J Ger iatr P sych iatry 2014 Oct 16 6-10 Moderate/Severe depression12 Aging Successfully, Vol. XXV, No. 1 email: [email protected] Questions? FAX: 314-771-8575

risiUcnivAerssitsy essmentated into the Electronic Health Record without permission and at no cost. __ Age: ________ Primary Care Provider Y / Nn Caucasian Hispanic Non-HispanicSARC-F Screen for Sarcopenia (Loss of Muscle)COMPONENT QUESTIONStrength How much difficulty do you have in lifting and carrying 10 pounds? Scoring: None = 0 Some = 1 A lot or unable = 2Assistance in Walking How much difficulty do you have walking across a room? Scoring: None = 0 Some = 1 A lot , use aids or unable = 2Rise from a Chair How much difficulty do you have transferring from a chair or bed? Scoring: None = 0 Some = 1 A lot or unable without help = 2Climb stairs How much difficulty do you have climbing a flight of ten stairs? Scoring: None = 0 Some = 1 A lot or unable = 2Falls How many times have you fallen in the last year? Scoring: None = 0 1-3 Falls = 1 4 or more falls = 2Total score of 4 or more indicates Sarcopenia. From Malmstrom TK, Morley JE. J Frailty and Aging 2013;2:55-6.Rapid Cognitive Screen (RCS)1. Please remember these five objects. I will ask you what they are later. [Read each object to patient using approx. 1 second intervals.] Apple Pen Tie House Car2. [Give patient pencil and the blank sheet with clock face.] This is a clock face. Please put in the hour markers and the time at ten minutes to eleven o’clock. Score 2 points if hour markers ok; 2 points if time correctWhat were the five objects I asked you to remember? Score 1 point/eachI’m going to tell you a story. Please listen carefully because afterwards, I’m going to ask you about it. Jill was a very successful stockbroker. She made a lot of money on the stock market. She then met Jack, a devastatingly handsome man. She married him and had three children. They lived in Chicago. She then stopped work and stayed at home to bring up her children. When they were teenagers, she went back to work. She and Jack lived happily ever after. What state did she live in? Score 1 point if correctSCORING: 8-10 = Normal; 6-7 = Mild Cognitive Impairment; 0-5 = Dementia From Malmstrom TK, Voss VB, Cruz-Oliver DM, et al. J Nutr Health Aging 2015;19:741-744. DO YOU HAVE AN ADVANCED DIRECTIVE? YES/NOQuestions? FAX: 314-771-8575 email: [email protected] Aging Successfully, Vol. XXV, No. 1 13

John Morley, M.B., B.Ch., Milta O. Little, D.O., is the new director of the Geriatric Medicine traveled to Geneva, Switzer- Fellowship Program. Dr. Little also presented a poster at the Harvard land to participate in the World Macy Scholar Showcase at the Asso- ciation of American Medical Colleges Health Organization Head- (AAMC) Annual Meeting in Chicago, IL. Her presentation, “Critical Reflec- Dr. Little quarters Experts Meeting, tion Transitions of Care” focused on the the medical stu- “WHO Knowledge NetworkDr. John E. Morley on Frailty and Sarcopenia,”focused on developing information about future agingaround the world.  dent education curriculum. Dr. Little was interviewed forCruz-Oliver Developing Palliative Missouri Viewpoints and the link can be found at http://Care Resources vimeo.com/111945931 with advice for the whole familyDr. Dulce Cruz-Oliver has been se- on how to have those sometimes difficult conversationslected as one of the ten members of the on arranging care when help is needed for day to day life.2015 Cambria Foundation Sojourns The GEC welcomes the following new faculty to theScholar Leadership Program. Dr. Cruz Division of Geriatric Medicine:is focusing her project on develop-ing the first Hospice and Palliative Ellen Kaehr, MD, has joined the Divi-Medicine fellowship program in Mis- Dr. Cruz-Oliver sion of Geriatric Medicine as an Assis-souri and creating the first outpatient tant Professor. Dr. Kaehr is a graduateclinic for palliative care services in the St. Louis region. Dr. of the Medical College of Wisconsin,Cruz-Oliver’s passion for this work is clear in her statement completed her residency in Internalabout this opportunity: “Several factors motivated me Medicine at Indiana University Schoolto become a doctor. Most importantly, I like to talk to of Medicine, and is an alumnus of thepeople, especially elderly people with advanced illness. Saint Louis University School of Medi- Dr. KaehrI was inspired by my grandmother who always received cine Fellowship in Geriatrics. She is certified by thesick people in her house where she cared for them with American Board of Internal Medicine in Geriatics.prayers and home remedies, and by my grandfather, whodue to prolonged illness, lived in my home where I helped Patricia Abele, MS, RN, FNP-BC, re-take care of him. Most recently, I have seen a close friend ceived undergraduate and graduate nurs-go through cancer and chemotherapy treatment. She encoun- ing degrees and post-Masters training intered many difficulties and challenges, some resulting from Family Nurse Practice at the Universitythe fragmented palliative care services in St. Louis, which of Missouri. Prior to joining the geriatricscaused her and all of us around her to suffer. This program faculty at Saint Louis University, Patty’swill advance improving care for patients in St. Louis who experiences include long term care, car-are being treated for a serious illness” (http://www.cambia- Patricia Abele diology, and heart transplant services. As a member of the geriatrics faculty, Patty healthfoundation.org/). is working in the residential care facilities and with the Julie Gammack, M.D., who has GWEP project. been serving as Assistant Dean On October 31, 2015, the Division of Geriatric Medicine for Graduate Medical Education, held the 5th Annual Geriatric Boot Camp. This is a free has accepted the role of Associ- half-day workshop for residents throughout the commu- ate Dean for Graduate Medical nity interested in geriatric medicine and possibly a geriat- Education and Designated Insti- ric medicine fellowship. For information on the upcomingDr. Gammack tutional Official. Congratulations Boot Camp scheduled for October 15, 2016, please call to Dr. Gammack!  314-977-8462 or e-mail Sue Brooks at [email protected] Aging Successfully, Vol. XXV, No. 1 email: [email protected] Questions? FAX: 314-771-8575

Pep TalkA for GeriatriciansBy Angela Sanford, MDOne day, shortly after becom- older patients being a challenge and shocked you would ever choose that field! I guess you weren’t gooding a geriatric attending physician how much I enjoy working with the enough to do anything else?” No, of course not, because that would beand when my white coat was still older patient population and their absurd!bright white and without pen stains families, particularly in the nursing Had I recovered quicker from my shock on that pivotal day, Ion the front pocket, I was in the doc- home setting. He responded shame- would have informed this physician of the importance of my specialty.tors’ lounge of a private community lessly with, “I thought only doctors Namely, that geriatricians routinely provide medical care to the frailesthospital when a surgeon approached who couldn’t get jobs worked in the and most vulnerable patient popu- lation. It takes a very special skillme. He introduced himself as “Dr. nursing home!” and then proceeded set to manage numerous complex medical comorbidities, all whileImportant Surgeon” and asked to hand me his card and say that weighing the risks and benefits of each intervention. I am constantlyme when I would be completing he would be happy for any refer- evaluating whether or not what I am about to prescribe or recommendresidency (strike one against “Dr. rals that I sent his way (strike two will improve quality of life or harm the patient, and more often than not,Important Surgeon”). The geriatric against “Dr. Important Surgeon”). there is a fine line between the two. To add complexity, our patients dofellow who was working with me an- Being the passive-aggressive indi- not fit into our most popular treat- ment algorithms because they are vidual that I am not the healthy 50-year-olds en- rolled in the studies that were used “... geriatricians routinely and not knowing to formulate the algorithms. I would how to express undoubtedly cause harm if I treated every older patient’s blood pressure provide medical care to my anger in an to 120/80 mmHg and started him/ appropriate way, her on a statin because of a remote history of a myocardial infarction the frailest and most vul- I walked over 30 years ago. to the trashcan Another pet peeve that I have nerable... I am constantly and ripped up encountered on numerous “Dr. Important occasions is the sentiment evaluating whether or that a fellowship in geriat- not what I am about to Surgeon’s” card rics is not particularly useful directly in eye- because other specialties (i.e., in- sight. ternal medicine or family practice) treat older adults. Yes, that may well prescribe or I have never be, as the supply of geriatricians forgotten that cannot meet the demand, but I recommend will day and luckily, (continued on page 16) have never run improve quality into “Dr. Impor- tant Surgeon” of life or harm the patient...” again. I assume he is still walk- ing the halls of the operating room ignorantly believing that nursing home physicians are the “reject doc-grily responded, “This is my attend- tors,” last in their medical schooling! She is done with her training!” class, who were unable to matchCompletely perplexed, he asked why into any other specialty. Have youI liked geriatrics and I went into my ever heard anyone say to an inter-usual spiel about the medical care of ventional cardiologist, “Wow, I amQuestions? FAX: 314-771-8575 email: [email protected] Aging Successfully, Vol. XXV, No. 1 15

Pep Talk (continued from page 15)guarantee that there are specific reasons we are “super-specialized specialists.” Since that airing, weissues and conditions that geriatri- have had hundreds of calls from older adults and their familiescians are better at diagnosing and seeking comprehensive geriatric assessment.managing. Take falls, for instance. Based on these results, it isWhat other specialty treats falls imperative that we lobby for the mainstream geriatric health soci-as well as we do? Geriatricians eties to advertise and advocate on our behalf. The general popula-understand that falls are multi- tion, as well as other physicians,factorial and have the skills to have little understanding of the advantage we cancomprehensively evaluate gait, provide. As patients and physiciansbalance, lower extremity strength, begin to see our inherentpolypharmacy, orthostasis, possi- value, more medical st u-bility of cardiac arrhythmia, and dents and residentsthe numerous other factors that will become in- terested in the field.contribute to fall risk. Patients In addition to increasing re-who are falling have been referred cruitment efforts is, of course, increasing reimbursement fromto me when “no doctor could fix Medicare and other health care insurers, but that deserves amom’s falls,” and have been able commentary article of its own and would require changing anto markedly decrease falls and fall entire culture.risk by checking a simple ortho- In summary, geriatricians need a pep talk. We need to ral-static blood pressure or stopping ly and exclaim in droves that we are the best at caring for oldernighttime Benadryl®. Granted, it adults. While most of us truly believe this in our hearts, weis not always that easy, but when let others’ misperceptions cloud our own self-worth. We are partit is, I might as well wear my bat- of one of the most fulfilling specialties and it is time for usman cape instead of my white coat to tell others how important we are!because I feel like a superhero and I look forward to administer- *To view the KMOV special,doctor. ing another cognitive screening “The Science of Healing,” visit www.aging.slu.edu.Similarly, consider dementia. test in the future. This patient had Questions? FAX: 314-771-8575Yes, probably any specialty could seen numerous doctors and hadperform a screening test and di- not been diagnosed with depres-agnose dementia, but I think geri- sion by any of them. Again, rollatricians develop a sixth sense to out the superhero cape becausedetect cognitive issues and the geriatricians are superheroes!ability to work up potential con- As geriatricians, we need totributing factors and causes in a unite and spread the word aboutcomprehensive manner. Just last how important we are. We are tooweek, a patient was referred to meek and humble and allow oth-me for “Alzheimer’s disease.” I ers to underestimate our abilitiesdid a simple screening for de- to truly improve patient care inpression and out of fifteen our older population. Yes, mostquestions, she answered physicians can care for olderpositively on thirteen of adults, but we do it better! Ourthem. She was severely de- Geriatrics Division at Saint Louispressed and I am sure that this University had the fortune to filmdepression is contributing to her a 30-minute special with our local“Alzheimer’s disease.” We put a television news station earlier thisplan in place to begin treatment for year that featured three membersdepression with an antidepressant of our department*. We providedand cognitive behavioral therapy the basics of geriatric care and the16 Aging Successfully, Vol. XXV, No. 1 email: [email protected]

Who’s Hearing Their Voices?Attending to the Needs of Dementia CaregiversBy Max Zubatsky, PhD, LMFT and Sue Tebb, PhD, MSW, RYT-500 Entering her 70s, Joyce never Joyce’s husband, Joe, started week- was directed to monitor his newthought that life would be this de- ly to misplace multiple items in the dementia medications.manding after retirement. Working home and lost track of the locationas a paralegal for much of her life, of his parked car. Joyce was also Throughout the first few yearsshe was ready to enjoy this new concerned with Joe’s new problems of Joe’s disease, Joyce receivedphase without the daily grind of in which he had difficulty verbal- very little support from familywork to stress her. Her upcoming izing thoughts or writing complete and friends, most of whom livedtrips with friends to South America sentences. Joe was a long-time ac- out of town. She was neverand Europe were all planned. Joyce countant and took pride in ordering asked by the medical teamwas also excited to get back to craft- his life based on numbers and cal- about Joe’s condition or hering and photography classes. She culations of tasks. After a series of own overall health and well-could finally spend more time see- memory tests administered by their ness. As time went on, Joe’s muscleing her young granddaughters who physician, Joyce and Joe were told strength started to decline. Joycelive only two hours away. Unfortu- that he had early-stage Alzheimer’s sacrificed thousands of hours tak-nately, her plans were dramatically disease. Joyce was given few re- ing Joe to appointments, makingchanged. Over the next six months, sources from Joe’s care team and meals, dressing and bathing him,Questions? FAX: 314-771-8575 (continued on page 18) email: [email protected] Aging Successfully, Vol. XXV, No. 1 17

Their Voices?(continued from page 17)and transferring him from the chairto the bed and back. She came to thestark realization that “this is going tobe the road for the rest of my life.”Joyce’s story is all too familiar.Family members and close friendsoften follow similar struggles andchallenges in the early years of theircaregiving role. After a diagnosisof dementia is received, primarycaregivers are often left alone won-dering, “Where do I even go fromhere?” Instead of transitioning intoa “non-work” role during one’sempty nest years, later life caregiv-ing places individuals in a new full-time job for which they received notraining or preparation. When care-givers are faced with these daunt-ing tasks of attending to their loved ligation they have to help the parent, on a limited amount of assessment from the patient.7 Little is knownone’s daily living needs, the moti- partner or spouse.2 As those suf- about the way in which physicians deliver effective care to dementiavation to attend to their own needs fering from the disease are living patients and work with families around the patient’s cognitive symp-and find meaning in their lives is longer, increased strains regarding toms and medication management.8 Many providers even sidestep theoften diminished or even lost. Had finances, medication management, conversation of dementia with fami- lies, fearing negative reactions orthe care team included Joyce as a assistance with activities of daily a lack of trust in their diagnosis of the patient.2 With these importantmember of the team and helped sup- living, and medical appointments conversations lacking during medi- cal appointments, caregivers are leftport her through this initial phase, often overwhelm first time care- unsure as to the road of their loved one’s health moving forward.providing her with the necessary givers. These constant sacrifices Healthcare providers shouldresources and tools, the pain of this for a loved one can frequently and consider the following questions when working with dementia care-journey may have been slightly alle- quickly take a toll. Long term de- givers following a family member’s diagnosis:viated. Now, the question becomes: mentia caregivers have increased How much does the caregiverwho will take care of Joyce if her risk of facing emotional, medical or know about the diagnosis and term dementia?emotional and physical health starts financial hardships along the way.3 Many times, caregivers are lostto decline as well? Health care professionals have and unprepared when attempting to identify signs and symptoms inFamily caregiving for persons found the care management for a loved one following a physician’s diagnosis.with a dementia diagnosis has be- those with dementia harder than Questions? FAX: 314-771-8575come more commonplace in the most chronic health conditions4 withUnited States. An estimated several unpredictable demands andeighty-five percent of un- challenges regarding symptoms andpaid caregivers who provide disease management for both theservices to a diagnosed in- patient and family.5,6 Primary caredividual are family members.1 providers have particularly difficultThese caregivers often want to be challenges with this diagnosis, con-the primary mode of assistance sidering that dementia is just one ofbecause 1) they (and others) desire hundreds of diagnoses they make into keep the family member in the routine care of patients. Diagnoseshome, 2) the proximity they have to often go undocumented in the pa-the person, and 3) the perceived ob- tient’s chart or misdiagnosed based18 Aging Successfully, Vol. XXV, No. 1 email: [email protected]

Their Voices? What level of stress is the care- In one study, the format of these in the area. Professionals are nowgiver going through? Caregiversvary considerably in the levels of groups is centered on what medi- seeking ways to include caregiversstress they can endure during theinitial phase of the disease. Low cal, mental health, and community in these groups, further impactingtolerance of stress for caregiverscan often lead to poorer health out- resources caregivers havecomes for both themselves and theirloved ones over time. utilized and their percep- What is the reaction of the tions of the journey car-caregiver following the delivery ofa diagnosis? While some caregiv- “Dementia caregivinging for a loved one withers may have predetermined a di- dementia. Participantsagnosis of dementia in their mind,others can be taken back even in- are being asked to report is, in itself, atimidated by the words “dementia,” personal challenges and“Alzheimer’s” or Parkinson’s dis-ease.” frustrations with their full-time job medical team ( physi- Does the caregiver have out- cia ns, ger iat r icians,side support through family,friends, and other resources? An nurses, and other profes- that requires aoverlooked aspect of caregivers’ sionals) regarding thestrain is the lack of outside supportfrom immediate or extended family. overall dementia careThose who assume all of the for- for the patient and care-mal caregiving responsibilities areprone to enduring significant strain significant amount ofgiver. The second studyand sacrifices in the quality of theirown lives. is examining the use of sacrifice available and supportive Is the caregiver going throughher or his own life issues (work, caregiving resources bymental health, physical health, orfamily circumstances)? Dementia health care providers and for loved ones.”caregiving is, in itself, a full-time job caregivers, specificallythat requires a significant amount ofsacrifice for loved ones. Detecting under-utilization and ex-any barriers or challenges in thecaregiver’s life can be valuable for isting barriers to use. Forphysicians and other professionalswhen directing individuals to refer- more information on these projects, the cognitive capacity and physi-rals and resources. contact Dr. Zubatsky at zubatsky- cal mobility of individuals with Currently, there are two focusgroup studies in the Saint Louis [email protected]. dementia. Lectures, seminars, andUniversity Department of Medi-cal Family Therapy and the School The Gateway Geriatric Educa- geriatric activities are provided byof Social Work that are aimed atexploring the experiences and tion Center (GEC) has several proj- GEC faculty on a local and nationalwell-being of dementia caregivers. ects that are striving to address the level to highlight strategies for cop-Questions? FAX: 314-771-8575 needs of dementia caregivers at all ing, prevention of burnout, and as- stages of the disease. “Caregivers sistance of loved one’s needs. More Like Me” helps Latino caregivers information for both dementia care- find strategies through the support givers and healthcare professionals of health care workers to keep their can be found at the GEC website at: loved ones in their homes longer. http://aging.slu.edu. Developed by Dr. Dulce Cruz- If providers are going to Oliver, the curriculum is available curb the stress and burn- in English and Spanish on the GEC out being experienced by website http://aging.slu.edu. dementia caregivers, inter- An innovative approach to im- vention at the initial diagno- prove memory and cognitive abil- sis is critical. Caregivers are often ity for individuals with dementia, the best reporters of “early warning called “Cognitive Stimulation Ther- signs” for their loved one’s condi- apy,” has been implemented in sev- tion and must be listened to more eral medical clinics, residential care closely at appointments and made facilities and community centers (continued on page 22) email: [email protected] Aging Successfully, Vol. XXV, No. 1 19

Geriatric Workforce Enhancement ProgramAnnounces 2016 Geriatric Leadership ScholarsThe Geriatric Workforce Enhancement Program with expertise in geriatrics and gerontology, the(GWEP) provides the opportunity for three faculty Geriatric Leadership Scholars Program provideseach year to be selected from colleges and support for these health care faculty to enhanceuniversities across Missouri to participate in their geriatric knowledge and skills. Scholarsthe Geriatric Leadership Scholars Program. This participate in and lead GWEP education events.GWEP initiative is aimed at developing competent Each of the Scholars are paired with a Gatewaygerontology faculty who have the skills to teach GEC Faculty Mentor who works with the Scholarand assess students is key to improving future care throughout the year to address teaching, research,for older adults and to develop healthcare faculty and program development issues.The 2016 Geriatric Leadership Scholars include: James Zubatsky, Cara Wallace, Olaide Sangoseni, Ph.D., LMFT, is an Ph.D., MSW, is an PT, DPT, MSc, Assistant Professor Assistant Profes- PhD, is an Assistant in the Saint Louis sor in the Saint Professor of Physical University School Louis University Therapy at Maryville of Medicine, De- School of Social University in St. partment of Family Work. Dr. Wal- Louis. Dr. Sangoseniand Community Medicine Medi- lace’s research, teaching, and has research and clinical activitiescal Family Therapy Program. Dr. clinical work focuses on  hospice in the areas of: evidence-basedZubatsky’s research and clinical and end-of-life care, family com- physical therapy practice, healthinterests include: family caregiv- munication, barriers to care, disparities and active aging issues,ing, geriatrics, community health and healthcare decision-making. health promotion and wellness, issues and disparities, col- During her Scholar experience, physical therapy practice advocacy, laboration in primary care, she is working with Drs. Dulce and manual therapy approaches to couples therapy, chronic Cruz-Oliver and John Morley to management of musculoskeletal illness in families, and conduct research and training in conditions. hoarding disorders. During these areas.his time in the Leadership Schol-ars Program, he is working with Applications are accepted each year of the GWEP project.GWEP faculty in the Caregiver If you are interested in learning more about the program,Support and Cognitive Stimula- contact Marla Berg-Weger, Gateway GEC, [email protected] Therapy Initiatives. or 314/977-2151.20 Aging Successfully, Vol. XXV, No. 1 email: [email protected] Questions? FAX: 314-771-8575

Visiting International ScholarsThe Division of Geriatric Medicine hosts three visiting international scholars Dr. Li Cao is spending a year with the Saint Louis (with Dr. Morley and Dr. Malmstrom), Association ofUniversity Geriatrics Division working with faculty Cytokine Levels and Depression in African Americanand staff. A graduate of the Sichuan University Medical Health study (with Dr. Morley and Dr. Malmstrom),School, Dr. Cao is an attending physician at the Center of Rapid Geriatric Assessment in Older Patients withGerontology and Geriatrics, Est China Hospital, Sichuan Cancer (with Dr. Morley and Dr. Tu), An ExploratoryUniversity in China. While serving as a visiting scholar Study to Evaluate Family Members a A Source of Im-at Saint Louis University, Dr. Cao is working on devel- portant Clinical Information for Older Patients withoping her knowledge of geriatric educational program is Geriatric Syndroms (with Dr. Flaherty and Pinwenengaged in research on the treatment of depression. Chen), Clinical Outcomes of Older Adults Admitted to Hospital (with Dr. Flaherty and Dr. Shum), Metfor- Dr. Li Cao arrived in the Geriatrics Division June min and Reduced Risk of Dementia (with Dr. Malm-2015 and will stay through May 2016. Her hospital, strom and Dr. Scherrer), and the Cochrane systematicwhich has over 4,000 inpatient beds and has over 2 review “Pioglitazone for Adults With High Risk ofmillion outpatient visits per year, was ranked #1 by Developing Type 2 Diabetes ” (with Dr. McKee and other Chinese authors). Dr. Chun “Alex” Keung Shum was with the Saint Louis University Division of Geriatrics from October – December, 2015. He is a geriatrician from the Depart- ment of Medicine and Geriatrics, Tuen Mun Hospital in Hong Kong. He also studied several aspects of health care and systems of care for U.S. elders, including Acute Care of the Elderly (ACE) Units, Delirium Rooms, Ortho-Geriatrics Hip Fracture Service, Palliative Care, Hospice Care, Skilled Nursing and Rehab Care, Outpa- tient Geriatric Assessment, and Home Care. His research included a quality improvement project on immobility of hospitalized patients and started a research project on the effectiveness of older patients on the ACE Unit.Dr. “Alex” Shum (l) and Dr. Li Cao (r)the Chinese Academy of Medical Sciences, Institute The Council for International Exchange of Schol-of Medical Information in the annual Chinese hospital ars awarded Sandra Maria-Lima Ribeiro, Ph.D.,technology influence. a Fulbright Scholarship. Dr. Ribeiro, an Associ- ate Professor at the University of Sao Paulo, Dr. Li Cao is studying several aspects of health care Brazil, served as a visiting scholar in theand systems of care for older adults in the U.S., which Division of Geriatric Medicine in late 2014she plans to develop when she returns to her hospital. where she organized the “Update on Nutri-Her areas of study include Acute Care of the Elderly tion in the Nursing Home” conference.  Her focus of(ACE) Units, Delirium Rooms, Ortho-Geriatrics Hip study is “Sarco-osteopenia and Sarcopenic ObesityFracture Services, Palliative Care, Hospice Care, in African-Americans, Prevalence and RelationshipSkilled Nursing and Rehab Care, Outpatient Geriatric With Biological and Socio-economic Variables.  JohnAssessment, and Home Care. Morley, M.B., B.Ch., served as her Faculty Associate at Saint Louis University.  While in St. Louis, Dr. Li Cao is involved in thefollowing research projects: Association of Depres-sion and Mortality in African American Health studyQuestions? FAX: 314-771-8575 email: [email protected] Aging Successfully, Vol. XXV, No. 1 21

Transforming Geriatric Care edge education for current and Their Voices? future geriatric professionals. The(continued from page 5) Gateway GEC has trained tens of (continued from page 19) thousands of public groups, stu-in one-on-one consultations, group dents and professionals across the part of the active health care team.sessions and online. region and country. Keeping caregivers emotionally and physically healthy is of utmost ••Teaching 220 health care “We know this community importance; providers need to con- professionals how to deliver very well, and the grant allows us tinue to assess and screen for any a non-drug treatment for to deepen and extend our previous risk factors with both the patient Alzheimer’s disease and re- impact with a new, broader fo- and the care provider during these lated disorders called Cog- cus,” says Berg-Weger. “Through visits. Training in health professions nitive Stimulation Therapy  our work in the primary care will greatly benefit medical care clinical setting, we will be able to professionals early in patient and Developed in the UK, cognitive reach a larger number of students, family care around neurodegenera-stimulation therapy is a low-cost, professionals, direct care work- tive diseases. Considering dementianon-pharmaceutical intervention ers, older adults and their support as a systemic disease, our healthcarefor those who have dementia that networks.” system can focus on those closelyhas been proven to be effective. The connected to the lives of patients.themed seven-week support group Morley said faculty, collabo- The well-being and quality of lifeengages and stimulates those who rating and community partners of dementia patients is only as goodhave dementia. It will be taught and other universities enthusias- as the ones providing care for them.at all training sites that are part of tically accepted the invitation to Otherwise, the next generation in ourthe project and to nursing, social participate in the new initiative. country will be forced to assume thework, occupational therapy, medi- role of “caretakers of the caregivers.”cal, communication disorders and “They’re excited to work withexercise science students. us to deliver quality care for older References persons and develop human rela-Building on Success tionships for care and healing,” 1. Gitlin LN, Schulz R. Family caregiving of The new project builds on the Morley said. “Our new project older adults. In: Prohaska RT, Anderson LA, presents an opportunity to make Binstock RH, eds. Public health for an agingstrengths of SLU’s Gateway Ge- transformative change in geriatric society. Baltimore, Md.: The Johns Hopkinsriatric Education Center, which care and education.” University Press;2012:181–204.had been funded by HRSA for 2. Alzheimer’s Association (2015). 2015 Al-over 22 years to develop cutting zheimer’s Disease Facts and Figures. Retrieved on February 18, 2016 from: www.alz.org/factsSLU Geriatrics is always on the 3. Papastavrou E, Kalokerinou A, Papacostasmove. Keep up with us! SS, Tsangari H, & Sourtzi P. Caring for a rela- tive with dementia: family caregiver burden. J facebook.com/GatewayGEC of Adv Nursing 2007;58(5):446-457. 4. Harris DP, et al. Primary care providers’ @GatewayGEC views of challenges and rewards of dementia care relative to other conditions. J Am Geriatr http://www.youtube.com/c/Gate- Soc 2009;57:2209-2216. wayGeriatricEducationCenterstl 5. Fortinsky RH, Zlateva I, Delaney C, et al. Primary care physicians’ dementia care prac-22 Aging Successfully, Vol. XXV, No. 1 email: [email protected] tices: evidence of geographic variation. Geron- tologist 2010;50:179-191. 6. Pimlott NJ, Persaud M, Drummond N, et al: Family physicians and dementia in Canada: Part 1. Clinical practice guidelines: awareness, attitudes, and opinions. Can Fam Physician 2009;55:506-507. 7. Boise L, Neal MB, Kaye J. Dementia assess- ment in primary care: results from a study in three managed care systems. J Gerontol Series A: Biological Sciences and Medical Sciences. 2004;59(6):M621-M626. 8. Fortinsky RH, et al. Primary care physi- cians’ dementia care practices: evidence of geographic variation. Gerontologist 2010; 50(2): 179-191. Questions? FAX: 314-771-8575

Upcoming Continuing Education Programs 27TH Annual Saint Louis University Summer Geriatric Institute Geriatrics in Practice June 6-7, 2016 St. Louis, Missouri USA For more information, call 314-977-8462. For registration information, visit aging.slu.edu Barcelona November 2016Questions? FAX: 314-771-8575 email: [email protected] Aging Successfully, Vol. XXV, No. 1 23

Non-Profit Org. US Postage PAID St. Louis, MO Permit No. 134Division of Geriatric MedicineSaint Louis University School of Medicine1402 South Grand BoulevardSt. Louis, Missouri 63104 This newsletter is a publication of: Division of Geriatric Medicine Department of Internal Medicine Saint Louis University School of Medicine Gateway Geriatric Education Center of Missouri (Gateway GEC) This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U1QHP28716 Geriatrics Worksforce Enhancement Program for $843,079. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by the HRSA, HHS, or the U.S. Government.John E. Morley, M.B., B.Ch.Dammert Professor of Gerontology; Director, Division ofGeriatric Medicine; Department of Internal Medicine,Saint Louis University School of Medicine.Marla Berg-Weger, Ph.D., L.C.S.W.Executive Director, Gateway Geriatric Education Center;Professor, Saint Louis University School of Social Work.Please direct inquiries to:Saint Louis University School of MedicineDivision of Geriatric Medicine1402 South Grand Boulevard, Room M238St. Louis, Missouri 63104e-mail: [email protected] issues of Aging Successfully may be viewed atht t p: //aging.slu.edu/agingsuccessfully.Some of the photos used in this issue are from www.istockphoto.com. So you won’t miss an issue, please send your new email address or mailing address to [email protected].