Human life cycle stage
Dr. Dustin Jones // #GeriOnICE // www.ptonice.com In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult division leader Dustin Jones discusses the scary stats of sarcopenia: increased risk of falls, fractures, loss of independence and the list goes on and on. Dustin emphasizes that rehab providers have HUGE opportunity in this department but often leave so much on the table. Listen in as Dustin shares some new research about Sarcopenia and it's implications for our work. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. DUSTIN JONES Alright Instagram, good morning, good morning YouTube. This is the PT on Ice daily show brought to you by the Institute of Clinical Excellence. My name is Dustin Jones, one of the lead faculty within the older adult division and today we are going to be talking about leaving nothing on the table when it comes to sarcopenia. Leaving nothing on the table when it comes to sarcopenia. We're going to be covering some new literature that looked at the variations of intensity of different exercises with and its impact on sarcopenia and what that means for us as clinicians or fitness providers. Before we get into the goods, I do want to mention CERT-MMOA is rocking. CERT-MMOA is for those that complete our three MMOA courses, our online level one and level two. then our live courses. We have shut things down for the rest of this year but I want to let you know as soon as 2024 kicks off in January we are hitting the road hard. Both of our online courses are gonna be starting that second week of January and then we've got a few courses I want to mention that are gonna be absolutely awesome in that month of January. We got Santa Rosa, California January 13th, 14th. On the 20th, 21st we're gonna be in Greenville, South Carolina the 27th and the 28th we are going to be in Missouri. So we'd love to see y'all on the road. SARCOPENIA So let's talk about this, sarcopenia. So sarcopenia, for those that are not familiar, is age-related loss of muscle mass and strength. Sometimes now you are going to see the word function or physical function be thrown into that definition, but by and large, most of the time when you see this, it is age-related loss of muscle mass and strength. This is very important for every single person listening to this podcast because the vast majority of y'all are treating older adults in some way shape or form. But what we're seeing is that the term sarcopenia is starting to apply to individuals that may not have that older adult tag on them. Maybe those folks that are south of 65, maybe those folks that are in their 50s, sometimes even their 40s that are gonna qualify based on the criteria of sarcopenia. So this is a big issue and it impacts a large, broad audience. Just some stats, just so you are aware of how this could impact the folks that you're serving. 10 to 40% that's a wide range, but estimates are saying that 10 to 40% of community dwelling older adults have sarcopenia. All right. So 10 to 40% of folks, independent older adults that are walking amongst this, out in the community walking into your outpatient clinic would be categorized as having sarcopenia. And we would argue that that number is largely artificially low, that there may be even more. If you are a clinician that is working in a more acute setting out of the community, right, like acute care, home health, skilled nursing facility, this number goes up exponentially. So for you all, the vast majority of individuals, particularly older adults, would fall into that category of having sarcopenia based on the diagnostic criteria. So all to say, a lot of folks across the whole healthcare spectrum would fall under this category. SARCOPENIA: WHAT'S THE BIG DEAL? Now why is this a big deal? This is a big deal because if you have that label sarcopenia, you are at 60% increased risk of falling, If you fall, you're at an 84% increased risk of having an injurious fall or with a fracture. Those are big statistics, and we know the negative implications of those health outcomes. It is a big deal. It is an absolutely big deal, and it's important for us to understand how big of a deal this is, but then also to know what to do with it, all right? And this is where this new research, this new literature that was just published comes into play. There's a recent systematic review and a network meta-analysis that was published in the European Review of Aging and Physical Activity that looked at randomized controlled trials that use exercise in different intensities of exercise and how that impacted different outcome measures with folks that have sarcopenia. So they found that there were about 50 randomized controlled trials that totaled of about 4,000 participants. And all of these studies looked at the following outcomes. They looked at muscle mass, which we're usually measuring with something like a DEXA scan, right? Muscle strength tested by hand grip strength, chest press, and then a leg press on a machine. And then physical function, functional outcome measures, five times sit to stand, 30 seconds sit to stand, timed up and go, short physical performance battery, which is, you'll commonly hear us refer to it as the SPPB, the six minute walk test, and gait speed. All right, so these studies were measuring a lot of things that have huge implications for a lot of physical therapy and even fitness outcomes. All right, so all these studies were looking at those things. and they performed exercise at different intensities. So they performed exercise potentially at light intensity. This is categorized as at zero to four out of 10 on that modified Borg score where we're looking at relative intensity or RPE, rating of perceived exertion. that could also equate to under 49% of someone's one rep max. So typically what you saw in this meta-analysis is that the randomized control trials that were using that light intensity, they were often using aerobic-based training. So we're going to throw that in, kind of that light intensity category. Then we had moderate intensity. So this was that five to six out of 10 on that RPE. kind of 50 to 69% of a one rep max was considered to be moderate, and then vigorous, six to eight out of 10, and kind of that 60 to 80% of that one rep max. All right, keep in mind the updated ACSM recommended guidelines are calling, particularly for sarcopenia, are calling for 60 to 80% of someone's 1RM. They're calling for vigorous exercise, in particular resistance training for these individuals, all right? So they had those different intensities and they saw, all right, what's going to happen here with these folks that have sarcopenia? And the interesting thing to think about this is there's a lot of individuals, particularly when someone has sarcopenia on board, that the main focus is that, hey, this person may be relatively sedentary. They have low physical activity levels. Let's just get this person moving, right? Let's get them started in some type of physical activity. Let's bump up their overall physical activity. That's going to be a huge win. I would agree with that. Anytime that we move someone from being relatively sedentary or low physical activity levels and we can bump that up, we are going to see some positive benefits. We cannot deny that there's good in getting people to move more. STOP STOPPING AT LIGHT INTENSITY But what we need to acknowledge, especially after these results, is we cannot stop there. That is the first part of the journey to pushing people to more activity, but more intense activity. So what they found with this meta-analysis is the individuals that only received that light intensity, the only improvements that they saw across all those different outcome measures that I mentioned before was they did see some improvements in their hand grip strength. Awesome, that's great. That's a great correlation to lots of health outcomes, right? It's not a bad thing to have an improvement in hand grip strength. Great, that's awesome. There's a point for light intensity exercise. Now, moderate intensity exercise saw improvements in hand grip strength and important outcome measures like a 30 second sit to stand, a timed up and go, and leg press. Awesome. That's a few points for moderate intensity. We should probably be giving more preference to that than light intensity. And then the vigorous intensity crew saw improvements in all of those things previously mentioned that the light and moderate intensity experience, but they also saw improvement in muscle mass. They saw improvement in gait speed along with 30 seconds at the stand, five times at the stand, timed up and go, hand grip strength, leg press, chest press as well. They saw significant improvements across that broad spectrum of outcome measures that I talked about before. They get 10 points for those types of benefits, right? So if we're to rank them, the vigorous benefited tremendously much more than the moderate and the moderate benefited more than the light. So what this is basically telling us is that these folks that had that sarcopenia tag, which is based on, you know, a DEXA scan, but then also, you know, SPPB under 8 out of 12 or hand grip strength under 26 kilograms for males and under 16 for females. That's what we would typically look at, right? SARCOPENIA NEEDS VIGOROUS INTENSITY Folks that have that diagnosis that we need to be giving them vigorous intensity activities, particularly resistance training. If we do not give them vigorous exercise, we are leaving a lot on the table. Yeah, they're going to get better. They're going to improve on some of these outcome measures, but we leave so much potential benefit on the table that we're ultimately doing a person a disservice. So based on this research, I wanna focus on three main takeaways that we should walk away with after coming across some literature like this, all right? The first one, particularly for the ICE crew, you have such a unique opportunity that you spend so much time with these individuals, comparatively more time than any other healthcare provider, that you need to be well-equipped to screen and identify when sarcopenia is on board. We cover this extensively in MMOA level one and in our MMOA live course, but you need to be able to run an SPPB. You need to be able to run a hand grip strength. You need to be able to interpret those results and let that influence your course of care, particularly for the outpatient clinicians, because why do people come to you, right? What is a primary driver for your services? People are typically coming to you for pain, which you need to focus on, but that may not be the biggest issue. All right. So one we're screening, we're identifying number two, we are leveraging intentional under dosage. You've heard us talk about this podcast before. We've done whole episodes on this. So I'd encourage you to search that if you had, if this is a new term for you, but we need to leverage intentional under dosage because that is typically we're lowering the barrier of entry for individuals. So they're going to partake in particularly a new activity, right? For so many of these folks, they have not exercised before, they've not performed any intensity of resistance training. This is completely new territory for these individuals that we need to make it approachable. And so we may typically underdose initially. SHORTEN YOUR UNDERDOSAGE But in light of this evidence, that intentional underdosage period needs to be as short as possible. We don't have a lot of time here with these individuals and we need to make the most of our time. The quicker we can get to that vigorous intensity level so we get all those benefits that this meta-analysis discusses, the better, right? So that intentional under-dosage period needs to be as short as possible. That's a very vague thing, right? For some individuals, you may have their first visit where it may be intentionally under-dosed for their capacity. and then the next visit based on their response, their trust in you, their willingness to perform maybe a more challenging activity, that intentional under dosage period may be the span of one visit, right? But I know for me, particularly in home health, I've had intentional under dosage periods that have been well into the months. based on the person that I'm working with. Whatever it is, make it as short as possible. So we screen and identify, we leverage that intention on your dosage. And then number three, and I think this is something that we really need to grasp, is the clinical urgency in this situation. that if you continue with your light, with your moderate intensity exercise with these individuals, you're leaving a lot on the table. And ultimately, you are harming that person. You are robbing them from the potential benefits that we've seen in this meta-analysis, that they see the big improvements in the functional outcome measures, in their strength, in their muscle mass. These people have the capability to get those kinds of results. And if we waste our time and spend too much time in that intentional underdosage period where we're doing that sedentary, doing light to even moderate intensity activities, you are doing that person a disservice. You are doing that person a disservice. It is a dangerous situation that you're playing with. We need to have a sense of urgency when we're talking about sarcopenia. All right. I'm going to drop the link to this meta-analysis at Open Access. Really good read. It gives you a good idea of kind of the big body of literature around sarcopenia, but what they found in terms of these outcome measures. I'll drop that in the comments. If you have a tough time getting that link, just shoot me, DustinJones.dpt or the ICE account a direct message and we'll get that over to you. But this is a big conversation for many of you. You all are seeing tons of folks that would have that sarcopenia label put on them if they were properly screened and identified and you have a huge opportunity to give them that vigorous intensity, that amazing dose that is going to give them huge benefits across such a broad spectrum of outcome measures that have a huge implication for their quality of life. Alright, y'all have a lovely rest of your Wednesday. Go crush it. I'll talk to y'all soon. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.
Dr. Jim McDonald, Commissioner of Health, New York State Department of Health, gives an order that allows New York pharmacists to administer RSV vaccines to older adults and pregnant people without a prescription; de Beaumont President and CEO Dr. Brian Castrucci says the book he edited with ASTHO CEO Dr. Mike Fraser, Building Strategic Skills for Better Health, is a must-read for every new or current public health professional; ASTHO plans a webinar to tell you how to improve access to emergency contraception; and sign up ASTHO's public health newsletters. New York State Department of Health Issues Standing Order to Allow Pharmacists to Administer RSV Vaccines to Older Adults without a Prescription ASTHO Webpage: Building Strategic Skills for Better Health ASTHO Webinar: Provider Strategies to Improve Access to Emergency Contraception ASTHO Email Newsletters: Sign Up Here
In this episode, Rick Zimmerman, MD, MPH, FAAFP, discusses RSV vaccines in older adults, including: Breakthroughs in RSV vaccine developmentRSV vaccine snapshot in older adultsFDA-approved RSV vaccines for older adultsCDC evidence to recommendations framework for vaccinesRSV burden in older populationsBenefits and harms of RSV vaccinationRSV vaccine efficacy and safety in older adultsCDC Advisory Committee Immunization Practices recommendations for RSV vaccines in older adultsPopulations at high risk for severe RSV diseaseVaccination considerations based on the upcoming RSV seasonFaculty:Richard Zimmerman, MD, MPH, FAAFPProfessorDepartment of Family Medicine and Clinical Epidemiology University of PittsburghPittsburgh, PennsylvaniaContent based on an online CME program supported by an independent educational grant from GlaxoSmithKline.Link to full program: https://bit.ly/49YBZ4rLink to downloadable slides: https://bit.ly/3GocjRe
Expecting mothers during 32 to 36 weeks and adults 60-years-old and older should get the RSV vaccine, according to CHI Health doctors. Dr. Michael Schooff, primary care medical director for CHI Health, said RSV can have a severe impact on infants and older adults. “They can get into a bronchiolitis or a pneumonia. Deeper and more severe infections in the lung can lead to difficulty breathing,” Schooff said. “People might need to go to the ER. Sometimes people need to be hospitalized and have help with breathing during these illnesses. And yes, sometimes it is fatal.”
Join Ellen Csepe as we discuss Creatine Monohydrate supplementation and potential benefits to older adults! Want to make sure you stay on top of all things geriatrics? Go to https://MMOA.online to check out our Free eBooks, Lectures, & the MMOA Digest!
In May 2023, the U.S. Surgeon General, Dr. Vivek Murthy, released an advisory calling attention to the public health crisis of loneliness and social isolation in the U.S. With this widespread issue affecting such a broad population, how does social isolation impact older adults? Dr. Alison Huang joins the podcast to share insights from her study on the relationship between social isolation and the risk of dementia in older adults. Using data from a nine-year National Health and Aging Trends Study (NHATS), she discusses how factors like living alone, limited social networks and reduced activity participation contribute to increased dementia risk. Guest: Alison Huang, PhD, MPH, senior research associate, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Show Notes Learn more about the U.S. Surgeon General's 2023 advisory, Our Epidemic of Loneliness and Isolation, on the U.S. Department of Health and Human Services (HHS) website. Read Dr. Huang's study, “Social isolation and 9-year dementia risk in community-dwelling Medicare beneficiaries in the United States,” on the Journal of the American Geriatrics Society website. Learn more about the National Health and Aging Trends Study (NHATS) on their website. Learn more about Dr. Alison Huang on Johns Hopkins Cochlear Center for Hearing and Public Health's website. Learn more about Alzheimer's disease prevention on our website. Connect with us Find transcripts and more at our website. Email Dementia Matters: email@example.com Follow us on Facebook and Twitter. Subscribe to the Wisconsin Alzheimer's Disease Research Center's e-newsletter.
One of the updated Cochrane Reviews from October 2023 is the third update of a review of the effects of vaccines for Herpes Zoster. It was conducted by a team of researchers in Brazil and we asked one of the authors, Juliana Gomes from the Department of Geriatrics and Gerontology at the Federal University of São Paulo, to describe its importance and main findings.
In this accredited podcast episode, Dr Christina Madison and Dr Mary Bridgeman provide practical strategies for implementing RSV vaccination into practice, including: Educating older adults on RSV vaccinesProviding effective, evidence-based recommendationsShared decision-makingIdentifying and addressing vaccine hesitancyProactive strategies in vaccinating for RSVPredicting and overcoming barriers to RSV vaccinationPresenters:Mary Barna Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAPClinical ProfessorErnest Mario School of PharmacyRutgers, The State University of New JerseyPiscataway, New JerseyInternal Medicine PharmacistRobert Wood Johnson University HospitalNew Brunswick, New JerseyChristina M. Madison, PharmD, FCCP, AAHIVPClinical PharmacistFounder and CEO, The Public Health Pharmacist, PLLCAdjunct Associate Professor of Pharmacy PracticeRoseman University of Health SciencesCollege of PharmacyHenderson, NevadaOther program activities: Frontiers in RSV Prevention for Older Adults: Developments, Recommendations, and the Pharmacist's Role https://bit.ly/49GUv1gLink to CME: Claim Credit – https://bit.ly/3uoY7VH[After selecting the “Continue to Post Test” button:]To receive continuing education credit, submit your posttest answers no later than the expiration of this activity. Select the best answer to each question. When you have completed all the questions, press the "Continue" button at the bottom.
Radio show host, Gary Calligas will have Jeffrey Witte, Fire Prevention Officer with Shreveport Fire Department on his Saturday, November 25th “The Best of Times Radio Hour” at 9:05 AM on News Radio 710 KEEL to discuss fire safety for older adults.. You can also listen to this radio talk show streaming LIVE on the internet at www.710KEEL.com . and streaming LIVE on 101.7 FM or via the RadioPUP or KEEL app on apple and android devices. For more information, please visit these websites at www.thebestoftimesnews.com and www.hebertstandc.com. This radio show is proudly presented by AARP Louisiana and Hebert's Town and Country of Shreveport featuring – Dodge, Chrysler, Ram, and Jeep vehicles and service.
Dr. Jeff Musgrave // #GeriOnICE // www.ptonice.com In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult lead faculty Jeff Musgrave discusses how to balance infusing patient care with hope with the reality of their recovery. Take a listen or check out the full transcript with show notes on our blog (www.ptonice.com/blog) or on your favorite podcast app. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. JEFF MUSGRAVE Welcome to the PT on ICE Daily Show, my name is Jeff Musgrave, Doctor of Physical Therapy. Super excited to be here on a Geri Wednesday. Geri on ICE is what we like to call Wednesdays, all things older adults. So today's topic is going to be all about a question I got this weekend while on a live course. So I had a student raise her hand, the reality of clinical practice here, and ask, how do we balance providing hope for our patients while still setting realistic expectations? How do we balance providing hope while setting realistic expectations? This is a reality of clinical practice for older adults when treating older adults. Lots of factors, and lots of things to dig in there. Before we get into that, if you're looking to see us on the road in 2023, your last opportunity is on December 2nd. That will be in Candler, North Carolina. Our other December offering already sold out. So that's your last shot in 2023 to see us on the road. Otherwise, we're coming out strong in January, team. We're going to be all over the map. We're going to be in Florida, California, Missouri, Ohio, and South Carolina in 2024. So we'll be coming in strong if you're hoping to see us live on the road. L1, previously called Essential Foundations, the next cohort is going to be on January 10th. then advanced concepts will be on January 11th. BALANCING PROVIDING HOPE WITH SETTING REALISTIC EXPECTATIONS Okay, so the question at hand is, how do we balance providing hope while still setting realistic expectations? important that we get this right. This is especially crucial for older adults. I want you to think about their history, and what their interactions are typically like in the medical system. A lot of people don't really give them the time of day. Their visits are rushed. People are throwing $10 words like idiopathic non-diabetic peripheral neuropathy that's what's wrong with you all right get out of my get out of my office kind of thing but we have a lot more time with our patients in comparison to a lot of other providers in the medical system and want to really leverage that time well. So as I've been chewing on this question, I gave the short answer during the live course, but I'm doing this podcast to give you the long answer for those that are interested. So it's like trying to find the narrow path, walking down a tightrope. We think about this journey with our patients from beginning to end. And the two factors that we're trying to balance here, if you can kind of imagine someone walking across a tightrope, they usually have this big pole that they use to balance. HOPE VS. HARD FACTS I want you to imagine on one end of this pole, we've got hope and this positive outlook, Because we know as physical therapists treating older adults, there's a lot we can do. A lot of people leave things like fitness and strength training, and power training. They have not incorporated any of those things. They need us. We can give them a lot of value. We can really do a lot of things to change their life. So we've got hope on this one end. And then we've got the hard facts. the realities of what's coming if they don't change, the reality of what is going to happen to them if they continue down this path. And we're trying to balance these two factors as we're walking with our patients down this path to recovery. So, long story short, the balancing act we're trying to do is we want to give a crap, make it clear that we care, we want to help, and we can help, without going so far that it sounds like we're full of crap. It's like, yeah, that's not possible, and exaggerate too much. But we want to be very clear that words matter. And if we go too far, too far on the hard facts, we can really shoot ourselves in the foot when it comes to recovery for older adults. You know, just a quick overview of some of the research. So Rebecca Levy, a researcher out of Yale, has done a lot of really interesting studies where she's looked at the power of positive beliefs in our belief systems, what we believe about aging, whether that's negative or positive, and how that may change our health outcomes. HOPE AS A POSITIVE TREATMENT FACTOR So she has done multiple studies looking at things like recovery from injury, like people that are hospitalized, if they are able to recover fully or not and she's found that people that are 50% more likely to recover to prior level function if they have a positive outlook on aging, talking about older adults here specifically. She did another study where she looked at people who had a predisposition for dementia if they had a positive outlook, even though they should have had an exponential increase in risk that should have led to them going on to have dementia if instead, they had a positive outlook on aging, they did not go on to get dementia as much as the rest of the cohort that all had that same predisposition. So there was an isolating factor of hope. And we think about when we have hope, we're gonna make different choices. If we believe we're in control and we are the ones charting our course in life versus life is happening to us. So hope is a very powerful tool. To summarize this, there's a great quote from Dr. Justin Dunaway out of our persistent pain course. And he says beliefs and expectations are the foundations on which outcomes are built. beliefs and expectations are the foundations on which outcomes are built. I love that. There was another really interesting study that came out of Harvard in 2007 and what they did, was they had several females, it was I believe it was about 45, don't quote me on that. It was somewhere around 45 to 50 females who had a very active job. They all worked in a hotel system where they were the people who were cleaning and turning over rooms. So they're moving all day. and we would say that they were physically active, they weren't getting fitness in, they weren't hitting ACSM guidelines, they weren't hitting Surgeon General's guidelines for fitness and lifting heavy things and hitting high intensity like we would recommend to truly be healthy. So they split this group to figure out if half of them were told that they were meeting the Surgeon General's guidelines and half were told they weren't, would there be any changes to their actual health measures? So they measured things like the hip-to-waist ratio. They also measured their BMI, their blood pressure, their body fat, and their overall weight. So they told one group, hey, the work you're doing, it hits the Surgeon General's guidelines. You're doing everything you need to do to be healthy. You don't need to exercise. And they told the other half, you're not meeting the Surgeon General's guidelines. You really need to exercise. This is not enough for you to be healthy. And what they did is they met back in four weeks and repeated all their health measures. They found that the placebo group had physical changes. They improved their weight, they reduced their body fat, their BMI was better, their blood pressure was better, and their hip-to-waist ratio was better. The power of words was tremendous for this group. None of them changed their behaviors. They were just told by a trusted source they're doing what they need to be doing and you should expect good things. Really incredible stuff. So we want to keep in mind providing hope is very important, especially to our older adults. They don't typically get a message of hope and we need to provide that because we have valuable tools. There are mountains of evidence showing that resistance training can help people get stronger in the early and late stages of sarcopenia. It's very important to provide someone with some hope. We don't want to take that too far and be completely full of crap, right? We don't want to tell our patients, oh yeah, you know, you can do these adductor ball squeezes, these leg kicks, and you're gonna be fine. You're gonna be prepared and protected for what life has coming at you. We know that is not true, and we're not suggesting that you grossly exaggerate, but we do need to give a healthy dose of hope. CONTENDING WITH REALITY So on the other end of the spectrum, we still have to contend with reality. What is a reality for our patients? What's the reality of the recovery going to look like? How much time should they expect the recovery process to take? And then we need to take a really honest look at what part of the journey we're going to be able to take them through. If you are an ICU clinician, if you're in an acute care setting, you may only see someone once or twice. You're going to give them hope and hopefully help them chart a path. Like, hey, this is going to go from here to home health. You need to find a good outpatient clinician. I know this great team. As soon as you're safe to get there, you need to get there. They will get you hooked up with a gym. And if you really want to change your life and stop coming back to the hospital, you can do that. You have every ability to do that. People have done it before. I've seen them change their lives. If you want to be another person to do that, you're going to have to commit for the next year. But then the decades to come are going to be way different than how your life has been the last month. Those adventures, those fun things you are planning to do, those can happen. That can be a reality for you. And that 45-second conversation could change someone's life. It may not always be, okay? We're not going to wear the rose-colored glasses, but your job is to plant those seeds. You still have to plant those seeds and let them know. Throw them a rope. They're still going to have to climb out of that hole, okay? So, we've covered the hope piece. We've talked a little bit about that scaffolding, but you need to create some scaffolding with reality in mind, okay? We know that there are tissue healing timeframes. that are on a range. We need to scaffold this up, that we need to know that we can get better but it's going to take X number of months and then inject yourself as to how far you're going to be able to take that journey. And day one, plant the seeds for what happens after. What happens after PT, after acute care, subacute, or if you're an outpatient clinician? What are their fitness options? You need to have these people on speed dial so you can bridge the gap, okay? And let them know. Just give them the whole story. Our older adults can handle it. They're used to getting tons of bad news. This is probably, even with a healthy dose of reality, some of the best news they're going to get because it's clear you care. There's hope. There's a path for them. But they need to know the realities and be prepared. What's coming ahead? So use science. Use the realities of tissue healing time frames to help them know, hey, this is how long this journey is going to take. Let's start thinking about these transitions moving along. Team, if we give too much reality and not enough hope, we're going to crush them. We're going to be kicking them while they're down. They're already maybe at a really pivotal point in their life. We give them no hope in all reality. They're going to quit. before it's time to get started before the real work begins. So based on the research that I just covered, based on the realities of being a human being, I would give a healthy dose of hope, and get them started, but we gotta balance that out just like you're walking that tightrope. You go too far either way, you're gonna fall off the path. We're gonna lose therapeutic alliance with our patients. They need enough hope to be ready that they're gonna have to struggle, they're gonna have to work hard, and it's gonna take a while. But there is hope they can truly change, that you've got the skills that you can provide, you know the people to make the transitions, and I think that is what's gonna lead to the most success for our patients, is balancing out science realities with tissue healing timeframes, knowing the person in front of you, and giving them a scale based on how much buy-in they're gonna give you. Are they willing to come into the clinic twice a week? Do they have a plan that supports that? Do they have the financial resources to support that? Or do we need a completely different plan where they're now motivated to do it at home and we need to spread this out and stay connected because we don't have good resources in the area? Alright team, I wish you the best of luck with your older adults managing those two factors, balancing hope and reality to get the best outcomes possible for our patients. I'd love to hear your thoughts in the comments. Have a happy Wednesday and I will catch you next time. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.
Survivorship Care of Older Adults: Addressing the Unique Needs Frank Penedo, Ph.D, University of Miami, Miami, FL Recorded on August 10, 2023 Tune in as we're joined by Dr. Frank Penedo from the University of Miami for an important discussion on considerations in survivorship care of older adults. Dr. Penedo outlines long-term and late effects of treatment, including psychosocial implications, and the impact of culture and language on survivorship. He also shares strategies for follow-up care coordination, as well as communicating with survivors and their families. Be part of the conversation today! This episode is supported by Bristol Myers Squibb; Genentech, Inc. & Biogen; Merck & Co. Inc.
In this accredited podcast episode, Mary Barna Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAP, discusses the most important things for pharmacists across all settings to know about RSV infections in patients 60 years of age or older, including: Incidence and prevalence of RSV in older adults, including hospitalization, mortality, epidemiologySeasonalityClinical manifestationsRisk factors for severe outcomesVulnerable groups and comorbiditiesPresenter:Mary Barna Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAPClinical ProfessorErnest Mario School of PharmacyRutgers, The State University of New JerseyPiscataway, New JerseyInternal Medicine PharmacistRobert Wood Johnson University HospitalNew Brunswick, New JerseyOther program activities: Frontiers in RSV Prevention for Older Adults: Developments, Recommendations, and the Pharmacist's Role https://bit.ly/49GUv1gLink to CME: Claim Credit – https://bit.ly/47GtNnK[After selecting the “Continue to Post Test” button:]To receive continuing education credit, submit your posttest answers no later than the expiration of this activity. Select the best answer to each question. When you have completed all the questions, press the "Continue" button at the bottom.
Jeff talks to Dr. Brent Forester about dementia and other cognitive disorders that are often found in older populations. They discuss the basics of Alzheimer's disease and other dementias, how to navigate treatment and support a loved one living with these conditions, and some of the current research going into the future of dementia care.Brent Forester, MD, MSc, has served as the chief of the Division of Geriatric Psychiatry at McLean Hospital and medical director for Dementia Care and Behavioral & Mental Health Population Health Management for Mass General Brigham. His research has focused on novel treatment approaches to manage the disabling behavioral complications of dementia, such as agitation and aggression.RELEVANT CONTENT:– More about the episode: https://mclean.link/th7– Read the episode transcript: https://mclean.link/o67- - -The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.© 2023 McLean Hospital. All Rights Reserved.
In this accredited podcast episode, Dr Mary Bridgeman discusses the most important things for pharmacists across all settings to know about RSV infections in patients 60 years of age or older, including: Incidence and prevalence of RSV in older adults, including hospitalization, mortality, epidemiologySeasonalityClinical manifestationsRisk factors for severe outcomesVulnerable groups and comorbiditiesPresenter:Mary Barna Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAPClinical ProfessorErnest Mario School of PharmacyRutgers, The State University of New JerseyPiscataway, New JerseyInternal Medicine PharmacistRobert Wood Johnson University HospitalNew Brunswick, New JerseyOther program activities: Frontiers in RSV Prevention for Older Adults: Developments, Recommendations, and the Pharmacist's Role https://bit.ly/49GUv1gLink to CME: Claim Credit – https://bit.ly/47GtNnK[After selecting the “Continue to Post Test” button:]To receive continuing education credit, submit your posttest answers no later than the expiration of this activity. Select the best answer to each question. When you have completed all the questions, press the "Continue" button at the bottom.
With reasons ranging from a lack of affordable housing to rising medical costs, more and more people over the age of 55 are experiencing homelessness. While the national data show the beginning of an alarming trend—with a 73-percent year-over-year increase in chronic homelessness among the elderly—the effects are in full bloom in Washington, DC. Abt's Brooke Abrams talks to Miriam's Kitchen's April Veney and Adam Rocap—who provide supportive services in the capital—about what they're seeing on the ground and how we can provide support and address root causes.
Patrick Roden, PhD, is the CEO of Aginginplace.com and author of Women, Aging & Myths: 10 Steps to Loving Your Long Life. Patrick talks about the free resources Aginginplace.com offers to support for older people and caregivers, how to change the narrative around aging, and the importance of lining up your tribe. About Patrick Patrick Roden Is a native of Oregon and spent the first years of his life crawling around the floors of a nursing home where his grandmother was head nurse. He feels this experience imprinted him and influenced his life's work. It was his "chance meeting" with 85-year-old marathon participant, Mavis Lindgren in 1992 that set Patrick on his current path. Acting as Mrs. Lindgren's medical escort for five marathons changed his view of what is possible in old age. Patrick's nursing career has spanned over three decades and includes ICU, CCU, Trauma Care, Inner-city Public Health, YMCA Cardiac Therapy Volunteer, and post-surgical recovery. In 2010 he was awarded The Lloydena Grimes Award for Excellence in Nursing from Linfield College School of Nursing (1st male ever to be awarded). He is a first-generation college graduate with a BS in Nursing, Masters in Adult Education and holds a Ph.D. in Gerontology. He is a Fielding University Creativity Longevity & Wisdom Fellow Human and Organization Development Scholarship recipient in recognition of scholarly contribution. Professional organizations include, The Oregon Nurse's Association, Oregon Gerontological Association, American Society on Aging, and he is a Certified Aging in Place Specialists (CAPS). He is the creative force behind aginginplace.com, author of the new book, Women, Aging & Myths: 10 Steps to Loving Your Long Lie, and a new series of Journals, What I Want You to Know About Aging, an intergenerational conversation starter and keepsake. Key Takeaways The “biomedicalization of aging” model views aging as a disease. Also called the “peak and decline model,” the focus is on pathology and assumes an individual has a few good years followed by a steep downward slide. Women, Aging & Myths: 10 Steps to Loving Your Long Life showcases women who are debunking aging myths. A chapter features Marianne Kilkenny who founded Women for Living in Community (WLIC) in 2007. WLIC has grown from an online website to a complete network of individuals, families, groups, and professionals, which focuses on the power of women as advocates and leaders for alternative housing choices. The narrative on aging needs to change. We are aged by culture not just biology. But we are aged by culture only if we agree to it.
Episode: November-December 2023 Host: Karl Steinberg, MD, HMDC, CMD Guest(s): Elizabeth Galik, PhD, CRNP In This Episode: In this episode, host Dr. Karl Steinberg, MD, HMDC, CMD, and editor-in-chief Dr. Elizabeth Galik, PhD, CRNP, discuss our November-December special issue on diabetes and the older adult. The articles they discuss include our feature story on how diabetes management is different in older adults and what this means for long-term care, diabetes care transitions, geographic health disparities, and what Dr. Galik learned from putting the issue together. There's many other great articles in this issue so be sure to check it out! Featured Articles: Diabetes Management Is Different in Older Adults, Especially Those in Long-Term Care Demystifying Diabetes Care Transitions How I Implemented What I Learned About Diabetes in This Issue of Caring for the Ages Geographic Health Disparities Date Recorded: November 7, 2023 Available Credit: The American Board of Post-Acute and Long-Term Care Medicine (ABPLM) issues CMD credits for AMDA On-The-Go and affiliate podcast episodes as follows: Claim CMD Credit
When an older adult needs to sell their home, they should seek out a real estate agent holding a Seniors Real Estate Specialist (SRES) designation. In the latest episode of Beyond the Balance Sheet, Adam Hayes, owner of Milestones Realty, explains the benefits of engaging an agent holding the SRES distinction. He also sheds light on the challenges older adults might overlook in today's real estate market. If you are considering selling your home, this is an essential episode you won't want to miss. IN THIS EPISODE: [2:04] Adam describes the difference between a Realtor and a Seniors Real Estate Specialist [7:59] Adam compares a home to a family member [9:33] Why older adults need help navigating the real estate market [14:12] How AI can play a role in deceiving a seller [21:50] Adam discusses knowing who the decision-maker is [24:20] Additional ways to protect your client [29:38] There needs to be a good relationship between the agent and the owner, and getting a qualified agent [34:29] What Adam has learned over the years KEY TAKEAWAYS: [20:01] Bad actors can steal items from a listed home if an agent is not careful what pictures they include in a listing [22:12] You must find out who the decision-maker is at the onset of the listing process [24:44] Pay special attention to the signage used on vehicles coming to the home. Those signs may alert bad actors. RESOURCES: Beyond the Balance Sheet Website Milestones Realty - Website Milestones Realty - Facebook Adam Hayes - LinkedIn Adam Hayes - Twitter BIOGRAPHY: Adam Hayes has been a Seniors Real Estate Specialist ® since 2008 and the Broker-Owner of Milestones Realty. Founded in 2009, Milestones is a trusted resource for many Elder Law Attorneys. It occupies an unexpected space among real estate brokerages as they focus on serving and advocating for Older Adults and Special Needs Clients. The genesis for Milestones was the unpleasant experience of rescuing my Dad from an unsafe living situation in 2001. Little did I know that my negotiating and people skills would be demanded just for the seemingly simple act of moving Dad into a Skilled Nursing Facility. My wife and I spent three months and several thousand driving- miles dealing with concerns, repairs, clean-outs, and other assorted loose ends. Years later, I thought, I'd been in training my whole adult life for that Olympian task, and nothing truly prepared me for the energy drain of helping him. I bring an “insider's empathy” to the equation and meet clients where they are emotionally and physically with unwavering respect for their tolerances and abilities.
Dr. Julie Brauer // #GeriOnICE // www.ptonice.com In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult lead faculty Julie Brauer as she discusses that the problem with patient education lies in the tendency of healthcare professionals to overwhelm patients with excessive recommendations, mistakenly believing that this approach is effective. They often act like a "fire hose," bombarding patients with information without considering whether it is truly understood or has a positive impact. This ineffective method of simply talking at patients, providing detailed explanations, or presenting long to-do lists is often learned from clinical instructors and perpetuated without recognizing its limitations. To enhance patient education, healthcare professionals should adopt a three-step framework. This framework involves "show and tell" by combining education with action and intervention, clarifying and recapitulating information to ensure comprehension, and following up and following through with patients to establish mutual accountability. By implementing this framework, healthcare professionals can avoid overwhelming patients and ensure the effectiveness of their education. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. JULIE BRAUER Welcome to the Geri on Ice segment of the PT on Ice Daily Show. My name is Julie Brauer. I am a member of the older adult division. Excited to be here with you all on Wednesday where we jam on all things older adults. Excited to be talking to you all this morning about patient education. Our topic specifically is patient education finish the drill. All right, so what we are going to talk about this morning is the problem with what many clinicians perceive to be effective patient education. And then I'm going to unpack a three-step framework that you all can use to level up your patient education interventions. And I'm going to then share a few really detailed examples of how you can implement this going forward using clinical scenarios that many of you all experience pretty frequently. The goal here is that we just walk into the rest of our week doing 1% better, okay? THE PROBLEM WITH PATIENT EDUCATION: THE FIRE HOSE All right, so what is the problem with patient education? The standard. Too often, we act like a fire hose. We flood our patients with too many recommendations, and we think that it's effective patient education. Team, we cannot fool ourselves. that simply talking at our patients, right? So explaining the very detailed pathophysiology of their condition or explaining their fall risk profile after running your outcome measures or giving them a 10 item to-do list of safety and lifestyle recommendations that they have never heard before and assume that we are making a positive impact. Many times I think this comes from the fact that we didn't really learn in school how to be effective at communicating to our patients and providing education. And then we just kind of followed what our CIs did, right? I am so guilty of this. I remember as a new grad going into a patient and you're so excited because you want to tell them everything in your brain that you know, you want to share your knowledge. And I remember I would just fire hose, fire hose for 10 to 15 minutes and I would walk out of that room and be like, man, I crushed it with Dolores. Like she just learned so much. I just did an awesome job. And then I would sit down and write literally a paragraph of all the things that I educated my patient on. And for some reason, because I wrote an entire paragraph of my educational interventions, that must make it good, right? Like I perceived that I did this awesome thing. So I think that's a scenario that we find a lot. The other scenario, which I've also been here, and many of you have probably been here too, is that you constantly have this productivity being shoved down your throat, or you are just so freaking burnout and so exhausted, you look at your clock and you're like, I gotta get this last patient in. I gotta get this last patient in. I'm exhausted. I don't have a ton of time. I don't know if I'm going to get a second set of hands to get them up to do any exercise interventions. So what am I going to do? I'm going to go into this room and I'm going to sit there and I'm going to educate. I don't even know if I can stand up to do it. So I'm going to just stay in my chair, educate and type as I'm there. I know a lot of us had been there, right? I know a lot of us have been there, but are we really helping our patient? Do we really think that just by sitting there and telling them a bunch of stuff, it's going to cause any positive impact? We have to really start to dig in there. So I want to offer you all a solution. I'm going to explain this three-step framework. So what does finish the drill mean? It means one, we're going to show and tell, Two, we are going to clarify and recap. And then three, we are going to follow up and follow through. So let me unpack each of those. SHOW AND TELL, CLARIFY & RECAP, AND FOLLOW-UP & FOLLOW-THROUGH Show and tell. Are we pairing our education with action on our part, an intervention, a demonstration? Are we facilitating action on our patient's part? Show and tell. Next, clarify and recap. Are we ensuring that the education that we are giving, the literal words, the process, the steps that are coming out of our mouths is actually being understood? Are we ensuring that the message we are sending is being received in the way that we intend? Are we asking the patient to recap what they heard? Are we asking questions to clarify misunderstandings or gaps in knowledge transfer? And then lastly, follow up and follow through. Are we following up with the patient after we make those recommendations? Are we following through with a caregiver or the next provider? Are we holding ourselves accountable and the patient accountable? That is what it means to finish the drill. Show and tell, clarify and recap, follow up and follow through. Okay, let's go through a few scenarios to give you guys a very detailed, clear example of how you can implement. I have a massive list of these, but I'm just gonna give you three here this morning, okay? All right, for you acute care clinicians, You have Dolores on your caseload. She has just had a lumbar fusion surgery, and you go in to evaluate her. Instead of just telling her, Dolores, you have movement restrictions. No bending, lifting, or twisting, right? We all know the BLT restrictions. What we know is that restrictions can cause a lot of fear. A lot of patients never discharge them and they walk around like they're in straitjackets for a really long time. So instead of just telling Dolores what she can't do, let's show and tell. Let's show Dolores how to hip hinge safely. and distinguish that from actually bending and flexing at the spine. So how do we do that? If many of all have been following ice for a long time, you know this awesome hack. You can take the toiletry bucket that is in Doris's room. You can go take some towels, roll them up, soak them in water and put them in the toiletry bucket. You can put that toiletry bucket on an elevated surface like the bed or the chair, and you can show Dolores how to safely hinge. Let's clarify and recap. Let's ask Dolores, hey, Dolores, do you have any questions about moving your back safely and rebuilding its strength? Let's have Dolores recap the points of performance of that hinge motion and demonstrate it for us. Lastly, let's follow up and let's follow through. If you are lucky enough in acute care to see your patient twice, let's say it's the very next day, or maybe it's later in the day, on the same day, you can ask, Dolores to set the environment up. Show me how to pick this up. We are checking for Dolores's ability to have those points of performance and be able to form that hinge movement. Let's follow through, which is very hard to do as an acute care clinician because many times you have no communication with the next provider. You don't ever get to see Dolores again. How can we do it to the best of our ability? We can follow through by talking to Dolores, maybe putting it on her phone or on a piece of paper. I need you to show this to your outpatient PT. And what does it say? Can you please teach me how to deadlift? Right? We are planting a seed, passing the baton, trying to make sure she stays in that fitness forward lane because we don't want her back on our caseload. Maybe we even take it a step further and we actually recommend to Dolores a specific fitness forward PT in the outpatient setting who we are going to want Dolores to go to. Finish the drill. Okay. Let's talk about a home health example here. So let's say you have Dolores in home health. We know that her visual acuity is impaired, right? Maybe you have done an acuity test. You know that her prescription on her glasses are really outdated. Let's not just tell Dolores about the importance of vision, helping her balance to prevent a fall. Let's not just tell her to make that eye appointment with her doctor and then walk out the door and hope that she does it. Let's show her how to send a message via MyChart. Guys, systems are starting to charge patients for MyChart messages. Let's start to show them how to send appropriate messages via MyChart, right? Let's make this actionable. What if we call the doctor, put them on speakerphone with Doris, guide Doris how to schedule her own appointment to increase her self-efficacy? Let's clarify with Dolores by asking, are there any barriers that you can perceive getting to this eye appointment? Let's follow through by contacting a caregiver to schedule with them. Hey, this appointment, Dolores has a eye appointment this day, this time. Are you going to be able to take her? Let's make sure it's on both of your all's calendars, right? Or maybe we plan ahead with a service like Go Go Grandparent so that we know that the transportation piece that was a barrier is now something that is facilitated and that we have taken care of that. Okay. Lastly, let's talk about an outpatient example. All right. You're working with Dolores, an outpatient. She lives with her partner at home. She's got some balance issues. She has had a fall. So you are treating her. Let's not just tell Dolores to take up her rugs and put nightlights around her house. How often do we give that cookie cutter recommendation of let's remove all your rugs, right? Instead, How about this? How about we make this actionable and we get Dolores or Dolores' partner or a caregiver to get a video walkthrough of the pathway from Dolores' from the edge of her bed into the hallway, into the bathroom, into the living room, out her front door, whatever her normal pathway is for the day. What if we get a video so that we can actually see what her home environment looks like? And then we can say, okay, Dolores, that rug, that one, the one with the tassels that you know she's probably gonna trip over or she has tripped over. Can we get rid of that rug, Dolores? Why don't we clarify by asking, Dolores, are you willing to get rid of that rug? She may, older adults, we know this guys, right? It's really hard to tell them to get rid of rugs. They may be really resistant to that. So Dolores, are you willing to get rid of that one rug? Because you have gone through and you've triaged out of all of the rugs, that's the one that's gonna cause us the most problem. What if we ask Dolores, what are your feelings surrounding getting rid of your rubs? And you dig a little deeper there. Let's follow through with talking about how we're going to actually get this done. Because maybe Dolores may not have the capability to get down on the ground and remove her rubs. So what if our follow through is calling nephew Johnny to ask him, Hey, will you, within this week, come over to Dolores's home and help her take up her rubs? Right? What if, We don't just tell Dolores to have those lights throughout the home. Now that we have the video, we say, Dolores, the lights would be most helpful if you put them here, here and there. Here is the Amazon link of some cheap but effective ones to buy. Let's put it in your cart right now. That is how we follow up and follow through and make this actionable, right? Then we can say, Dolores, here's your follow-up. Bring in a video in the next week and show me what your pathways look like now. So you are able to see that we have followed through with this recommendation. The nightlights are where they're supposed to be and the rugs are taken out. Guys, this is what it means to finish the drill with our educational interventions. Show and tell, clarify and recap, follow up and follow through. I would love to hear you all take this framework into the rest of the week. And while you're with your patients and you're starting to just fire hose and spew out those recommendations, I would love for you to pause take the pause and really think how you're going to finish the Drew. How are you going to show and tell, clarify and recap, follow up and follow through? All right, team, that's all I got for you today. Lastly, let's talk to you all about our courses that are coming up. We have some sold out courses, which is wild to have at the end of the year. November, we have a sold out course in Illinois. In December, we are sold out or we're very near sold out in Portland, Maine. And then we have another chance for you all to catch us on the road in Asheville, North Carolina. In January 1st of the year, we are going to have both of our online courses, our Level 1 and Level 2, formerly known as Central Foundations and Advanced Concepts, that are going to be starting up on January 10th and 11th. You know where all that info lives, ptinex.com, mmoa.online. Hit us up if you have any questions. Go out there and start to make those educational interventions. Just 1% better team. All right, y'all. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.
In this new segment, Cam and Andrew will be going through some data, research articles, opinion pieces, and other interesting literature to make it a palatable, easy to digest content piece for you to take with you. In this new segment, Cam and Andrew will be going through some data, research articles, opinion pieces, and other interesting literature to make it a palatable, easy to digest content piece for you to take with you. WHAT IS THE FIRED UP PODCAST? Started in 2019, Cam Hewett and Andrew Happel, two personal trainers, started the podcast as a fun project to work on in their free time hoping to bring fitness education to the masses through audio content. Fast forward to today, the Fired Up Podcast has become a regular podcast with regular listeners, who knew that could happen!? Cam and Andrew aim to educate, motivate, and connect individuals to fitness in order to integrate great fitness principles into the community at large. CONTACTS: IG - @cam_hewett IG - @coachhappel IG - @fireduppod email - firstname.lastname@example.org email - email@example.com https://p10gym.com/
Dr Elena Portacolone joins Ethics Talk to discuss her article, coauthored with Daisy Elise Feddoes: “Should Artificial Intelligence Play a Role in Cultivating Social Connections Among Older Adults?” Recorded August 14, 2023. Read the full article for free at JournalOfEthics.org.
In part two, physician experts discuss the key takeaways from part one and go through the next patient scenario to demonstrate best practices in geriatric care using behavioral health integration (BHI). Physician guests are David Baron, MSEd, DO; Karen Dionesotes, MD, MPH, psychiatry resident; Stephanie Nothelle, MD, assistant professor of medicine. For more about the BHI Collaborative Overcoming Obstacles Series, go to www.ama-assn.org/bhiresources.
As the holiday season begins, Home Instead is encouraging Richmond-area residents to participate in the "Be a Santa to a Senior" program, which spreads holiday cheer to older adults in the community who may lack companionship during the holidays. This year, program coordinators hope to collect gifts for 125 older adults, and have partnered with local fire departments to deliver the gifts to the seniors. To participate, shoppers can email the Home Instead Richmond office and receive a gift request from a local senior. Emails should be directed to program coordinator Kelly Criste-Cook at firstname.lastname@example.org. After receiving a gift request, shoppers...Article LinkSupport the show
This week @sbship8_dpt discusses the importance of sleep for the older adult and some research articles to check out the subject. “Sleep in the Elderly” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723148/ “Sleep health promotion: Practical information for physical therapists” https://academic.oup.com/ptj/article/97/8/826/3831304 #MMOA #oldnotweak #sleep #olderadults Want to make sure you stay on top of all things geriatrics? Go to https://MMOA.online to check out our Free eBooks, Lectures, & the MMOA Digest!
This week we're joined by Danielle Arigoni, Managing Director for Policy and Solutions at The National Housing Trust. We chat about Danielle's new book Climate Resilience for an Aging Nation as well as housing policy that benefits everyone. You can find Danielle's book at our Bookshop Affiliate site or at Island Press. OOO Follow us on twitter @theoverheadwire Follow us on Mastadon email@example.com Support the show on Patreon http://patreon.com/theoverheadwire Buy books on our Bookshop.org Affiliate site! And get our Cars are Cholesterol shirt at Tee-Public! And everything else at http://theoverheadwire.com
Today's episode marks the return of another Ask Me Anything episode where listeners ask Ken and Dawn to weigh in on a wide range of topics. In this go-around, listeners certainly had a lot on their mind. At the top of their list were questions about AI and especially the Bing AI chat bot that reportedly wants to be alive so it can steal nuclear secrets. Ken, who is Fellow of the Association for the Advancement of Artificial Intelligence, also answered questions about the future of AI and whether AI might one day be able to do a better job of writing fact-based news stories than humans. Other questions listeners submitted asked Ken and Dawn for their take on: The competing recommendations for the daily intake of protein for healthy aging. The future of therapeutic ketosis. What it means for Chat GPT to “hallucinate.” Whether we'll discover the existence of other life in the universe in the next 20 to 50 years. The potential of kratom to help relieve joint and arthritic pain. And at the end of the show, Ken talks about his high school coach in response to a listener asking Ken about some of his mentors when he was a youth. Show notes: [00:02:20] A listener asks Ken if he has heard the story of a Bing AI chat bot telling a reporter that it wanted to be alive, steal nuclear secrets and create a deadly virus. The listener also asks if Ken thinks that AI possessing human aspirations is on the horizon. [00:03:23] A listener asks Ken to explain how Chat GPT works in detail, but also in a way that a lay person can comprehend. [00:06:01] Ken weights in on what it means for Chat GPT to “hallucinate.” [00:08:14] A listener notes in their question that Donald Layman, in his interview on STEM-Talk, suggested a higher protein intake for healthy aging than what the FDA recommends. The listener goes on to note that Valter Longo, a previous STEM-Talk guest, recommended the opposite. The listener notes that Ken and Marcas, who hosted the Don Layman episode, seem to favor Layman's interpretation over Longo's and asks if Ken could elaborate on his position. [00:11:12] A listener mentions that the benefit of a ketogenic diet for metabolic disorders is well established, and notes that the frontiers of therapeutic ketosis, as mentioned in Dom D'Agostino's appearance on STEM-Talk, is very exciting. The listener asks Ken what he would like to see as the next frontier for therapeutic ketosis research. [00:12:41] A listener asks Ken if people should be paying more attention to their ApoB levels instead of their LDL levels. [00:14:39] A listener asks Ken about a paper published in July in Frontiers in Neuroscience, titled: “Overnight Olfactory Enrichment Using an Odorant Diffuser Improves Memory and Modifies Uncinate Fasciculus in Older Adults.” The paper reports that the use of a diffuser with seven different essential oils, a different one for each day of the week, had a remarkable effect on memory. [00:16:55] In light of the John Ioannidis interview on COVID-19 and the discussion of our national response being based on unreliable data, a listener asks Ken and Dawn for their thoughts about the reliability of the COVID tracking data by Johns Hopkins. [00:19:02] A listener asks Ken about a comment he made during the John Ioannidis interview about the substantial decline in trust in our institutions and the media and how reestablishing trust would require more and better transparency and accountability. The listener asks what that transparency and accountability would look like. [00:20:36] A listener asks Ken about Ed Weiler's interview on STEM-Talk, where Ed said that we will be able to prove the existence of other life in the universe in 20 to 50 years. The listener asks if Ken is as confident in this claim as Ed. [00:26:37] A listener asks Ken about the news regarding technology leaders and researchers issuing a warning that new powerful AI tools in development present a profound danger to...
Three physicians highlight best practices in geriatric care and actions their teams can take using behavioral health integration (BHI) to provide quality, whole-person care to the patient and their caregivers. Physician guests are David Baron, MSEd, DO; Karen Dionesotes, MD, MPH, psychiatry resident; Stephanie Nothelle, MD, assistant professor of medicine. For more about the BHI Collaborative Overcoming Obstacles Series, go to www.ama-assn.org/bhiresources.
The Founder of Booming Encore talks about how the digital media hub provides information and resources to help people design and live their best later life. About Susan Susan Williams is the Founder of Booming Encore – a digital media hub dedicated to providing information and inspiration to help people create and live their best later life. Susan is also the co-author of the book, Retirement Heaven or Hell: Which Will You Choose? and contributor to the book, Longevity Lifestyle by Design. Susan frequently writes and publicly speaks about the opportunities and challenges related to aging, retirement, and longevity. Key Takeaways Older adults are choosing “slash careers” instead of retirement. An example is business analyst/dog walker We need to retire the word retirement. As people are living beyond standard life expectancy the whole concept of retirement is being questioned from a societal and personal perspective. Retirement means to withdraw, to pull back. Age-tech like wearables and sensors are being developed to support the 90% of people who want to age in their homes.
Dr. Dustin Jones // #GeriOnICE // www.ptonice.com In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult division leader Dustin Jones discusses the difference between sarcopenia (the loss of muscle mass) and potentiapenia (the loss of muscular power). Dustin reminds listeners that performing functional outcome measures & then creating a treatment plan based on functional deficits uncovered during assessment is the most important thing in ensuring patients receive the individualized care they need: "Assess, don't assume." Dustin also discusses the utility of using functional outcomes to assess & track progress so that insurers like Medicare will continue to pay for treatment. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 - DUSTIN JONES All right, welcome y'all. This is the PT on ICE Daily Show brought to you by the Institute of Clinical Excellence. My name is Dustin Jones, one of the lead faculty within the older adult division as we call MMOA. We're going to talk today about a really interesting topic. We're going to name the enemy and that is potentiopenia. We're going to name the enemy particularly when we're working with older adults and that is potentiopenia. This is brought to you by a listener question, a commentary that they wrote and I want to dive into the topic of power, strength, Sarcopenia as well. What should we really be focusing on? How can we screen? Before we get into the goods, I want to mention about some upcoming MMOA live courses. MMOA live is a part of the cert MMOA curriculum. Part of that curriculum is a live course. Also our MMOA level one online course, which was formerly called MMOA essential foundations. And then MMOA Level 2, which was formerly called Advanced Concepts. You complete all three, you get your cert MMOA. We have three upcoming weekends where you can go to that live course. We're gonna have Annapolis, Maryland and Central South Carolina. This upcoming weekend, November 11th, we're gonna be in Wappinger's Falls, New York. And then right before Thanksgiving, November 18th, that weekend, we're gonna be in Westmont, Illinois. So if you are looking to get some Con Ed before the end of the year, be sure to check us out. PTOnIce.com is where you can find all that. POTENTIAPENIA All right, so naming the enemy, potentiopenia. So this is a term you probably have never heard about because it's not been coined, it's not been researched, it's not been agreed upon in literature. This is a word that was made up by Dr. Ronald Michalak. So Dr. Michalak is an orthopedic surgeon that's been practicing for roughly 20 plus years that has quitting his surgical practice to go back and pursue his PhD in Rehabilitation Science. Dr. Michalak is an avid listener to the PT on ICE Daily Show, so I want to take the time to shout out to him, but also for all of y'all that listen to this show that aren't our typical physical therapy crowd, right? The OTs, the speech-language pathologists, the other healthcare providers. I know we have some PAs, some NPs in here, but we're really grateful for y'all tuning in because we're starting to see we have a fitness-forward army clinicians that are trying to solve the same problems. This is one example. So Dr. Mitchell like you know 20 plus years doing orthopedic surgery you start to see some patterns right? You start to see the issues with focusing on the tissue, right? Of focusing on, oh, that bone-on-bone, we should probably just go ahead and replace that whole joint, and that will solve all your problems, right? There's some issues to that, that when we focus so much on the anatomy, the structure, that we apply surgical interventions to non-surgical problems, that creates issues, right? And so over his career, he started to see, man, the biggest issue is not the quote-unquote bone-on-bone, it's the fact that these folks are deconditioned, they're weak, they're not able to do the things that they want to do and it leaves them susceptible to some of these medical situations that I'm often performing surgery on. What can I do to prevent them from even having surgery? And so we started to dig into the research and science and what he has come to the conclusion of is we are really missing the boat to where we're focusing on the wrong things and what we need to focus on particularly with this population is their lack of power. hence the term potentiopenia, the lack of muscular power. So, I want to give some context for this discussion because I think it's really interesting of how much progress has been made in this area, particularly in geriatrics and geriatric rehabilitation. SARCOPENIA So, sarcopenia, you've heard us talk about this so many times on the PT on ICE Daily Show. If you've taken any of the MMOA courses, you've heard this term. Sarcopenia was first coined in 1989 by Dr. Rosenberg, and at the time, the definition, the accepted definition of sarcopenia was age-related loss of muscle mass. That we thought, oh man, these folks are losing muscle mass, therefore, they are losing their strength, they are losing their ability to do what they need to do. This is a big issue. It's age-related, but we may be able to do something about it. As this was studied more and more, and just this whole concept, was being critically you know thought about that the term of sarcopenia or the definition of sarcopenia was missing a little bit right because you can have someone that is losing muscle mass but may still be really strong or you may have someone that does have a good bit of muscle mass that is rather weak or they're not able to produce their force quickly aka they have low power So, in 2008, Dr. Clark really started to push against this definition of sarcopenia and say, hey, this isn't the issue. The issue is the lack of strength, the age-related loss of muscular strength. And he coined the term dynopenia. That was a back and forth, back and forth. And now in terms of the term of sarcopenia, what we're seeing is that it's starting to incorporate some of the things that Dr. Clark really was pushing for. And now you're often going to see sarcopenia defined as the age-related loss of muscle mass and strength. That's what we speak to in the MMA course. And so a lot of the screens that you're seeing of being able to identify folks that have sarcopenia are mass related screens of actually measuring muscle mass and having cutoffs based on certain age groups and so on and so forth. But then there's also functional measures, right? Gait speed is one, grip strength is another one, the SPPB, the short physical performance battery test can indicate that someone is at risk of sarcopenia. Sarcopenia has changed a ton over the past few decades. Now, what's interesting is that the amount of research, which is so massive in this particular topic, that we have really good evidence to show, man, if this person scores below one meter per second, for example, on the gait speed, that this individual is at risk of sarcopenia, also a host of negative health outcomes. It's very predictive. We have a lot of data to show that poor performance on some of these outcome measures is a big issue and very predictive and warrants medical treatment or physical therapy, if you will, or occupational therapy, some of these rehabilitation-based services. Now, here's the issue. Here's what I think Dr. Michalak is going towards, is a lot of these screens that have been used to say, hey, this person has sarcopenia, age-related muscle mass and strength, that these screens may not actually be measuring what we think, right? If you think about gait speed, normal gait speed, for example, is that a measure of strength? Not really, right? Is it a measure of, let's say, power, the ability to produce that strength quickly? Potentially, right? Definitely, if it's a fast gait speed, or if we're looking at gait speed reserve, the difference between max gait speed and normal gait speed. Think about the 30 second sit to stand test, where we're standing up and sitting down 30 times. Is that a measure of strength? You can make a strong argument that, no, not necessarily, but it's more of a measure of how people can use that strength quickly to perform that transfer. Same thing could be said for the five times sit to stand. And so these outcome measures that are often tied to quote-unquote sarcopenia, the age-related loss of muscle mass and strength, isn't really measuring that. We can say that those tests are very predictive of some of these negative health outcomes. That's not what we're talking about. What we're talking about is do these tests actually measure, indicate what they're saying that they measure, right? Now, here's the, I think the important part about this is that if I am performing a five-time sit-to-stand test or a 30-second sit-to-stand test and think that, oh, this indicates that this person has impaired lower extremity strength and I focus on strength-based interventions, right, I'm just worried about getting them stronger, not necessarily trying to help them get stronger, produce force quicker, aka power. THE NEGLECT OF POWER-BASED TRAINING And so what Dr. Michalak is really proposing is that our focus on age-related loss of muscle mass and strength, the focus on strength has resulted in the neglect of power-based training. We need to really think differently about these terms and ultimately what they result in. I think we should have a new term, potentiapenia. That was his argument. This is all in a beautiful commentary that I loved reading that I'm going to link in the notes. So here's our take on this. I agree that… we have really dropped the ball on power-based training, right? That we often neglect that in this population for many reasons. One is just we haven't named the enemy as one. Two is that we often have ageist assumptions about what people can handle, right? That, oh, that's too intense for them or they will get hurt. It's not as well studied as strength-based training. There's a lot of reasons that go into that, but I do agree that we have really dropped the ball there. A new term, creating a new term, and everything that's associated with that, I don't know if that's the answer, but I do think we need to continue to be critical of the term sarcopenia and what that actually represents. It's already changed to age-related loss of muscle mass and strength, which is lovely, and I would love to see that conversation continue to include power as well. Clinically, here's what I think is really important for us when we think about some of these deficits that folks are undergoing and we're throwing around some of these terms. STRENGTH VS. POWER TRAINING I think the big thing that needs to be focused is we're diving into the weeds of strength versus power and you know reps and sets and volume and all that type of stuff that when first one is when we're working with individuals that are relatively sedentary or inactive and Movement is king. I don't care what they do. The fact that they are moving is ultimately important, right? We got to get people moving first and we need to be less picky of what that looks like, especially with sedentary and active individuals. That's the first thing. The second thing is we need to really think about our assessments and challenge our assumptions with this. This is why in our courses we always say assessments over assumptions. It's very easy for us as clinicians, when you're doing an assessment, you're doing the five-time sit-to-stand test, 30-second sit-to-stand test, to assume, oh, this person needs to do more lower extremity-based strength training, right? That's a very common thing for us to correlate. Now, that test may not be and probably isn't testing pure strength, right? There's other ways to do that. One rep max testing, estimated one rep max testing. We can use dynamometry as well. There's other methods to test strength. These functional and very practical outcome measures may be more a testament to someone's power ability. So when we use these tests, particularly the 30 seconds sit to stand, five times sit to stand, I think is a great example. that we need to be thinking probably about strength training, but we also need to be thinking about power training. Can they produce that force quickly? Because it ultimately is an indicator of power, the ability to produce that force quickly and do that transfer. So what your outcome measures tell you, we need to be very careful of how that informs the intervention, right? And ultimately what we're often going to find, I think this is not an or conversation, strength training or power training, in the realm of ice, you will hear this so often, it is and not or, right? Probably both, strength and power, we can do both. In reality, when we do get people stronger, you often see, especially in folks that are untrained, you are gonna see an improvement in power production. You could do specific power training, where you're doing force movements quickly, you're probably using lighter loads, and you're probably gonna see an improvement in strength, right? That's gonna happen with a lot of untrained individuals. But I think in the context of rehab, in the context especially of One Rep Max Living, that we probably want to do both. Heavy loads are really good. Heavy loads provide an amazing stimulus to promote muscle mass, our strength, but also the strength of our bones, also our soft tissue remodeling. It makes us more resilient individuals. But fast loads are really good too, right? They give us that type 2 muscle fiber stimulation to prevent some of that preferential decline. in those fibers. That quick speed is so practical for so many things that we do in the real world and also in high-risk situations. It's an and conversation. We want to do both. Now, Dr. Mitchell, I had two specific questions that I also wanted to hit on. Could referrals be written or phrased better from the physician end to encourage PTs to try to help get these individuals moving toward fitness? Now, I want everyone to listen here, and by and large, the PT on ICE Daily shows largely physical therapists, physical therapy assistants. Think about what this physician just asked. This physician is basically saying, where are my fitness forward clinicians, right? Where are my fitness forward clinicians? Where are the people that I can trust with my patients? I love this question. I think from our angle, from kind of the rehab fitness side of things, Let it be known. What are you about? Lock arms, lock shields with us, the ICE tribe, the ones that are really pushing this fitness forward message because there are healthcare providers looking for you. Now, Dr. Mitchell, from the physician's standpoint, I do think it is helpful to make it clear as a physician that you have that fitness forward approach. And oftentimes, we don't see that on referrals, right? It's the diagnosis and treat, which you love as a PT, to be honest, but if you do run a 30 second sit to stand and acknowledge that it is under or below a particular cutoff let it be known and let it be known what you are thinking about that it is a potential loss of power production potential right and let the PT do the job of assessing to determine is this a bigger power issue or a bigger issue of just producing force of strength. FUNCTION-FORWARD HEALTHCARE PROVIDERS But let it be known, I love it whenever I see another healthcare provider perform some type of screen, like a 30 second sit to stand, a timed up and go is another one, that tells me that this is a function focused healthcare provider. And we're speaking the same language, especially when we're coming from the MLA tribe. We speak function, we speak that fitness forward mindset, include some of that information and that's really going to get the point across particularly to the fitness for clinicians. I would also say Dr. Michalak is go to PTOnIce.com, look at the find an ice clinician map and build relationships with that person that is local. The second question that he asked was, are there any insights into Medicare billing or reimbursement that would allow them to do so and actually get paid for their expertise? So the question here is mainly looking at, he's interacted with some PTs where he sent the referral that was not pain based, where these clinicians said, I can't get this covered, right? I treat pain, I get paid to treat pain. That is not correct, right? So you can definitely get reimbursed to have the fitness forward approach when you use appropriate outcome measures. When you can demonstrate medical necessity through the performance of these validated outcome measures that we cover extensively in our MMOA level one online course, and a little bit as well in our MOA live course, when we're using those outcome measures to demonstrate, hey, this person has a score, which based on the literature is showing that they are at a higher risk of whatever, negative health outcome, usually it's a fall, that that warrants your services. It is medically necessary. So we can have fitness-forward physical therapy. This is what we often see in the context of home health. We treat more function than pain in the context of home health. Outpatient, not so much. It's more of a pain driver, but you can still have a fitness-forward approach in the context of outpatient. These outcome measures are absolutely key because they demonstrate medical necessity. Multiple outcome measures I should say great conversation. So what I want y'all to do if you like this topic I want you to come to Instagram and I'm gonna drop a couple links. You could also send me a direct message At Dustin Jones dot DPT and I'll send you the links as well because it's a really great conversation. I think by and large Yes, we need to get people stronger We're already really pushing forward with that and I love that but we may need to take it to the next level of power based training In terms of a new name, potentiopenia, I don't know. I'll let the really smart people debate that and discuss that, but I'm going to keep pushing the message that we need to build people's resilience. We need to end one rep max living and really show that people may be quote unquote old, but not weak. Also that they may be quote unquote old and not slow. Y'all have a good rest of your Wednesday. I'll talk to you soon. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.
Dr. Christina Prevett // #GeriOnICE // www.ptonice.com In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult division leader Christina Prevett discusses that the fountain of function is muscle mass and estrogen in the aging female. Christina breaks down these two areas for function, and what we have physical therapist can do to help encourage both muscle mass and estrogen preservation. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 - CHRISTINA PREVETT Hello, everybody, and welcome to the PT on Ice Daily Show. My name is Christina Prevett. I am one of the team within our Modern Management of the Older Adult Division. In our division, we have three courses in our geriatric curriculum. We have our eight-week online Essential Foundations course. We have our eight-week online Advanced Concepts course. And we have our two-day live course. We have a couple of courses that are left in the remainder of the year. We have a course coming up in November in Chandler, North Carolina. We have another course coming up in South Carolina. And we have a course coming up in Texas in December. So if you are near those courses or you are looking to get in some content before the end of the year, I encourage you to check those courses out. and you'll be able to get in with some of our faculty before, you know, we ring in 2024. 01:18 - THE FOUNTAIN OF FUNCTION Today I'm going to talk about the fountain of function. And so this is a reframe that I think is really important. And we're going to talk about what those fountains of function are. You'll notice that I did not say fountain of youth. We have this idea in our society that youth is the goal, to not feel like we're getting older in any way, to not show signs of age on our faces. And don't get me wrong, I see my aging face, I was like, oh, my face doesn't look like I am 21 anymore, and I look at the wrinkles on my face, and I have those emotions. But the idea for my life is not to try and get younger. It's to try and optimize my reserve and try and live the way that I want to live with the most amount of function possible into my 30s and 40s and 50s and 60s and hopefully all the way up to 100. Because at MMA and within ice in general, Aging is a privilege. It is something that I am very thankful for because the alternative is not that great. We're not gonna be able to reverse back time, but we can have a really successful aging process, especially when we put in the steps to live the way that we want to live, whatever that filter means for us. So I'm not looking for the fountain of youth. I am looking for the fountain of function. And so the two types, the two areas that are the fountain of function in aging women, so I'm going to talk about female anatomy, is muscle mass and estrogen. And these two things, especially when taken together and optimized to the best of our capacity, is going to allow us to have more function towards the end of our life. So let's talk about muscle mass. You have not been following the Institute of Clinical Excellence in any ways if you don't know that LODE is our love language across all of our division, across all of our faculty, and that is absolutely true in the geriatric curriculum as well. And I love it so much that I did an entire PhD on the influence of resistance training in an aging body. When we look at resistance training, we are accumulating a growth and a continuation, a plethora of education and research that looks at the impact of resistance training on health outcomes. And I just posted a paper that was a narrative review from Stu Phillips, who is one of my committee members on my PhD. 04:18 - THE COMING OF AGE OF RESISTANCE TRAINING And he talked about the coming of age of resistance training and how we are starting to see some accumulation of evidence that is mirroring and is just as strong as literature that we're seeing in aerobic training to prevent stave off different chronic diseases, including some cardiovascular diseases. And so there means that there, as of course, we're going to target the aerobic system. This is not to say to not do cardio in stead, just do resistance training, but it's showing that there is a continual and persistent growth of literature talking about the impact of resistance training on health outcomes. So what we see is that those who have more muscle mass tend to have lower all-cause mortality. They are less likely to develop cardiovascular conditions. They are better able to manage diabetes. They're less likely to get diabetes. We know that muscle mass is protective around things like osteoporosis, right? Tensile strength of the bone is important and we need impact, body weight movements, resistance training across the lifespan in order to optimize that. We see that individuals who are stronger or less likely to have sarcopenia, right? Sarcopenia is clinically relevant amounts of muscular weakness that are preventing a person from completing their day-to-day tasks. It's a totally important output of frailty. Fried's physical phenotype of frailty talks about physical reserve and physical capacity as an output of individuals seeing these constellations and signs and symptoms that lead to vulnerability to external stress. That external stress includes things like hospitalizations and being able to withstand different stressors with respect to immune system insults, including things like COVID-19, pneumonia, and the flu that allows individuals, while they are sick, to have that reserve and resiliency to lean back on in order for individuals to be able to get back to baseline or improve past baseline, post-hospitalization, or acute insult. All this to say, we know that individuals need to be trying optimize their muscle mass in their earlier life and then hold on to it for as long as possible. If you are in a setting where you are not working with individuals who have optimized their muscular mass, we also know that muscular mass can be developed and we can see improvements in physical function with resistance training at any age when we start including in our 90s. The mechanism at which strength develops is a little bit different. We're looking a lot more at neuromuscular efficiency. However, we can absolutely see that it can improve function. And so whether you are 30 or you are 85, muscle mass is a fountain of function and it allows us to withstand stress. 12:24 - ESTROGEN FUNCTION & MENOPAUSE Now let's kind of talk about this second piece, which is estrogen. I've done several podcasts on menopause, but I want to talk about the influence of estrogen around female physiology, because I think this is really important. So when we are going through the menopausal transition, on average, individuals will start menopause between 50 and 51. Definition of menopause is when you've gone a full calendar year, 12 months without a menstrual period. That is your menopausal transition. But individuals can be experiencing perimenopausal symptoms that are indicators of dwindling or are coming down of estrogen status for up to 10 years prior to the transition into menopause. And so individuals who are in their early 40s can start to see the influences of loss of estrogen on their body. And then that influence is persistent as individuals get older. When we're talking about menopause, we often are putting this into two camps. So we have vasomotor symptoms, which are these symptoms that occur because of an acute withdrawal of estrogen. These are things like night sweats and hot flashes. As individuals transition through menopause and we get into our later life, into our 60s, 70s, 80s, and beyond, those symptoms tend to decline. So those vasomotor symptoms that occur as our body transitions to reductions in estrogen status they tend to go down as our body gets used to this new state of equilibrium that occurs without estrogen. In the opposite direction, the second kind of camp that we speak about when individuals are going through menopause is genitourinary syndrome of menopause or GSM. And that is signs and symptoms across the female physiology that are responding to losses in estrogen. and anywhere where there is an estrogen receptor within our body, they are going to experience changes when individuals transition through menopause. And we oftentimes will, in the pelvic health space, talk about changes to our reproductive anatomy, which are unbelievably relevant, but we have to also extrapolate that out and talk about different areas where estrogen is influencing female physiology and how, if you are working with an aging female, they are experiencing changes because of that change in estrogen status. And so within the reproductive track, we see that there is changes in ligamentous stability around the pelvis. And I hate that word stability, but it's a change in the turnover of the way that our ligaments are restructuring. So we have a little bit more ligamentous breakdown than buildup, right? That turnover rate is different. And so we have this shift between static support in the pelvis to the requirements or dynamic support around the pelvic floor. We see that individuals start to have vaginal atrophy. We see that the vaginal microbiome starts to change. We don't have the same cervical mucus secretion. And so things like chafing and redness can be more prevalent in a person who is postmenopausal. We can see fusing of the labia minora and majora. and this can lead to increased risks for pelvic floor dysfunction. So when we are in estrogen low states, rates for pelvic floor dysfunction go up. This includes anal incontinence, urinary incontinence, pelvic organ prolapse, dyspnea, or painful punitive intercourse, and other aspects of the reproductive tract. We also see, because of this change in the vulvar anatomy, that we have an increased risk for things like urinary tract infections, that increased risk for urinary tract infection also influences individual's physical function. We know that recurrent UTIs can be a cause of changes in cognitive status for our aging females. And so something that is extremely relevant for our aging women. Other things that we see is that as individuals go into an estrogen depleted state, increased risk of cardiovascular disease goes up. Individuals as they transition through menopause, we see that in general, men tend to be more impacted by cardiovascular disease. That is shifting for a lot of different reasons, but that risk profile increases when individuals are in an estrogen depleted state. We see a change in central adiposity where weight starts to increase. Adiposity accumulation can increase, especially visceral fat accumulation, which has a risk profile in and of itself for different chronic diseases. And then we see, for example, in our bone microarchitecture that the influence of estrogen allows for continual bone regeneration and that profile again starts to switch and there's an increased risk for things like osteoporosis in an estrogen deficient state. So there's a lot of things that get impacted, right? Our skin gets impacted, our breast tissue gets impacted, our urinary tract, all of our mucosal membranes, not just in our vulva, but across our entire body, and this has impacts. And so when we are thinking about working with these individuals, one of the things that is starting to become really recommended is topical estrogens. And there's a lot of debate about this because of a study that had been done a little while ago that looked at increased risk for sex-related cancers, breast cancer, endometrial cancer, cervical cancer, et cetera, with systemic estrogen. However, what we are starting to see now and many of our menopausal experts like Dr. Mary Claire and Dr. Rachel Rubin are really trying to have this public health approach to medicine saying that we are not doing our females a service when we are saying that there is a risk profile when subsequent studies have not been able to substantiate or replicate those findings. And so there's been a big shift in the last five years to the need for or the desire for many women who are really suffering with genital urinary syndrome of menopause to be able to take things like topical estrogens in order to really significantly reduce their symptom burden. And I'm not just talking about their pelvic floor, which is an extremely important part of their sexual health, also a vital sign of aging, but also, you know, all of these other physiological signs of estrogen deficiency that are impacting our outcomes, right? We see that individuals with that combination of muscular mass, we are seeing individuals with negative consequences of osteoporotic fracture. if we were able to be preventative in this approach where we are talking about estrogen supplementation when these symptoms start to arise, especially when they hit a threshold of bother, where there's going to be this spectrum, some individuals are very bothered and very impacted by the signs of vasomotor symptoms and genital urinary syndrome of menopause, and then some individuals are not, but for those individuals with bother, is this something that should be taken? Is this something that they can talk to their physician about? Is there this literature to support these topical estrogens? And we are starting to see this mounting of evidence that is starting to come up to help individuals in the aging process. So many of our aging adults are being told that this is just what they should be living with. This is because they're going through menopause. Deal. We saw this in the peripartum space where there's a lot of advocacy still happening with respect to not having this thought process that as soon as you have a baby that pelvic floor dysfunction is just something that you should live with. We're starting to see this rise up in our perimenopausal and postmenopausal population, where they are not accepting that this is what they should be doing. They're not being dismissed anymore for these symptoms, and it's super important. When we take this lifespan approach, this education becomes extremely relevant. Talking about the peripartum space, I truly believe that that is where we start to tell females that they are not resilient, that they are somehow fragile, that they need to be concerned for their organs falling out and all these different pelvic floor dysfunctions. And then they are not encouraged to be as resilient as they could be by taking part in heavy resistance training or impact activities or things at higher intensities. We start bringing that intensity down and the idea of, ooh, be careful or, oh, monitor this or, oh, if you have these symptoms, it's time for you to stop participating in those activities. We are seeing this shift and what this shift is going to do earlier in life is it's going to set up are aging individuals with this mindset that pelvic floor dysfunction one is not inevitable two that reserve is protective when it comes to muscular reserve and three they're going to be advocates for their own health and that includes their hormonal health and that includes not accepting that some of these symptoms of menopause are things that they just need to live with, but things that can be medically managed. Genital urinary syndrome of menopause is a syndrome condition. It is a medical diagnosis, and therefore it is something that we can be treating. As physical therapists, us being educators and conduits of that knowledge translation is extremely important. And then we are going to optimize function for these individuals. Last point that I'm going to make, because I ended up being a lot more long-winded than I thought I was going to be, is that we are now seeing this interaction between menopause, genital urinary syndromes, and long-term health outcomes. We are seeing that individuals with higher physical activity, combination, aerobic resistance, or both, are having a much lower GSM burden than those who are not. And so again, it comes back full circle, whether this health promotion is extremely important, that not only are we gonna optimize a person's muscular reserve, we're gonna make that fountain of function be extremely relevant, but we're also going to make the quality of that function a lot better because their quality of life is better because we are not allowing them to just live with these symptoms and be dismissed by our medical system, us included, that just expects this to be the way that it is. And so this advocacy piece is extremely important and it's something that we are going to be screaming from the rooftops. All right, everyone, I hope you have a wonderful week. I'm going to be diving a lot more onto my page and I'm going to be collaborating it with ICE and MMOA around hormone therapies for individuals with GSM. I am not a medical physician, so I encourage you to reach out to your urogynecologist and urologist in your area. Get that relationship with them so that you can start having these conversations and we can start talking about risk profiles. All right, have a wonderful week. If you are not on our MMOA digest, I encourage you to sign up for those newsletters. Otherwise, have a wonderful week and I will talk to you all again soon. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.
Elder law attorney Kerry Peck joins John Williams to answer all your questions about elder law, trusts, wills, and elder abuse. Kerry discusses a new survey that shows that Americans are more concerned about helping their aging parents than they are about receiving an inheritance. Kerry also talks about the benefits of remote work for those that […]
Elder law attorney Kerry Peck joins John Williams to answer all your questions about elder law, trusts, wills, and elder abuse. Kerry discusses a new survey that shows that Americans are more concerned about helping their aging parents than they are about receiving an inheritance. Kerry also talks about the benefits of remote work for those that […]
Elder law attorney Kerry Peck joins John Williams to answer all your questions about elder law, trusts, wills, and elder abuse. Kerry discusses a new survey that shows that Americans are more concerned about helping their aging parents than they are about receiving an inheritance. Kerry also talks about the benefits of remote work for those that […]
In today's episode, we dive into a fascinating and often overlooked topic—The connection between insomnia and loneliness among older adults. As we age, our sleep patterns change, and it's not uncommon for older individuals to experience sleep disturbances. Loneliness, a widespread issue among this demographic, can be a significant contributor to these problems. About Meghna Dassani Dr. Meghna Dassani is passionate about promoting healthy sleep through dental practices. In following the ADA's 2017 guideline on sleep apnea screening and treatment, she has helped many children and adults improve their sleep, their breathing, and their lives. Her books and seminars help parents and practitioners understand the essential roles of the tongue, palate, and jaw in promoting healthy sleep. Connect with Dr. Meghna Dassani Website: https://www.meghnadassani.com Facebook: https://www.facebook.com/healthysleeprevolution Instagram: https://www.instagram.com/healthysleeprevolution/ Youtube: https://www.youtube.com/@meghnadassanidmd197 Get a copy of Airway is Life: https://www.airwayislife.com Get a copy of The Tired Child: https://thetiredchild.com
Dr. Jeff Musgrave // #GeriOnICE // www.ptonice.com In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult lead faculty Jeff Musgrave discusses the significant issue regarding the lack of individualization and care for older adults with cognitive impairments. Jeff points out that many older adults on their caseloads are at different stages of cognitive impairment, but this often goes unnoticed until it progresses to advanced dementia. The problem lies in the one-size-fits-all approach to treating cognitive impairments, where individuals with mild impairments are grouped together with those with severe impairments, or they are treated the same as the general population without screening for cognitive impairments. This lack of individualization and care for older adults with cognitive impairments is also evident in nursing homes. Jeff mentions a study from Germany that examined a population of nursing home residents. The residents were grouped based on their cognitive and physical impairments. However, the study found that there was a lack of personalized care, as a more diverse group was randomly assembled with varying levels of cognitive and physical function, and they all received the same basic intervention. Jeff emphasizes the need to tailor care to the individual's cognitive capacity, just as their physical capacity is considered. He uses the analogy of coaching a peewee football league, where practice would not be taken to the local NFL team if the capacity is not appropriate. Similarly, individuals with cognitive impairments should not receive interventions that are beyond their cognitive abilities. However, in the current state of rehabilitation for those with cognitive impairments, interventions are often not matched to their cognitive abilities. This lack of individualization and care for older adults with cognitive impairments is a significant problem that needs to be addressed. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 - JEFF MUSGRAVE Welcome to the PT on Ice Daily Show. Good morning, my name is Dr. Jeff Musgrave. Super excited to be with you this morning, talking about a topic that's really important to me, but also reviewing a research article eight days off the press, a new technique called clustering to give better care to those with dementia on our caseloads. But before we get into that, if you're looking to up your Geri game, we are available. We've got some extra seats in our New Jersey course in Matawan, New Jersey this weekend. If you want to hop on that train, we'd love to have you. We've got space for just a few more. Next weekend, if you want to join us for live, we'll be in Annapolis, Maryland or in Central South Carolina. Last cohort of Essential Foundations just kicked off. We've got our first live meetup, so sorry if you missed it. We will be up in full force in January 2024. There is still time to catch advanced concepts if you want to sign up for that. The last cohort is about to begin, so grab those seats. 02:42 - JEFF MUSGRAVE So team, man, I'm so excited to get to talk to you about this topic. There are so many older adults on our caseloads in various stages of cognitive impairment. And this oftentimes goes unrecognized until it becomes advanced dementia. when things are a bit harder to turn the tide, but also there's a severe lack of individualization and care for those that have cognitive impairments. A big problem in general practice is this one size fits all. In geriatrics in general, whether we're talking about physical impairments, but unfortunately we see the same problem when it comes to cognitive impairments. We see those with cognitive impairments get treated the same regardless of how advanced those symptoms are. So we see one of two big problems here. We either see those with very mild cognitive impairments grouped with those with very severe impairments, Or we just see them treated the same because no one's screened or picked up on the fact that there's a cognitive impairment on board and they're treated just like the general population which is also not appropriate. So neither of those are a good look. So this study out of Germany was looking at a population of residents in nursing homes and what they did is they clustered them based on their cognitive as well as their physical impairment. So they used a clustering approach to try to get homogeneous groups of people based on not only their physical function but their cognitive function. So all these residents were 65 and up. They had mild to moderate dementia and were living in a skilled nursing facility. The physical measures that they used were the six minute walk test, the timed up and go, 30 seconds sit to stand. But the biggest place where they saw variation that dictated their function was on their mini mental state exam. So their cognitive impairment did a lot to dictate their function. So what they found at the end of this was that those that had more advanced cognitive impairments were not able, even if they had the physical function, to participate in as high level balance training as those that had more severe cognitive impairments. So those with more mild cognitive impairment were not able to participate at the same level, in particular when it came to balance challenges. 04:56 - COGNITIVE IMPAIRMENTS & TRAINING The interventions for this study unfortunately the link did not go through that I could see all the details but what they what they were doing was some form of strength training either seated if there was lower physical function versus standing or dynamic movement in standing if they had higher physical function. So lower to higher physical function and then they gave also a cognitive layer to their interventions while they were doing balance or strength training. So that allowed them to scale the intervention to those who, to make it more appropriate. So they had a higher and lower physical function, higher and lower cognitive function group, and they scaled the cognitive load as well as the instructions So one big thing that's missing is the environment and the type of cues that we give typically in clinical practice for those with cognitive impairments also need to be scaled. They can't be as complex of cues with multiple sentences in the same duration of time. We've got to really scale that to the person in front of us and individualize that care based on their cognitive capacity, just like we would their physical capacity. The way I kind of think about this is if you were coaching a peewee football league and practice is going really well, you would not march them over to the local NFL team for practice. Their capacity is not appropriate. But we do the same thing with cognitive impairments where we've got someone who has more advanced cognitive impairments, getting a much higher level of training than what they should be and it's no surprise when the results aren't as good and that's also what was found in this study was the experimental group had the matched physical and cognitive and then there was a more heterogeneous group that was just kind of randomly put together with higher and lower cognitive and physical function, and they all got this lowest common denominator intervention, which we commonly see, especially because this was looking at group training in skilled nursing facilities. What typically happens is we've got this big group of people, and we find the person with the lowest cognitive and physical function, and we give everyone that. So the person that has the lowest physical and cognitive function gets an appropriate challenge. Everyone else has lots more ability that is not tapped into and is not being challenged. So it's no surprise once you hear that's what's happening, which unfortunately is the state of rehab for those that have cognitive impairments in general, is it's not being matched to their cognitive ability. So those that were not matched based on their cognitive and physical function showed decline in their mental function by the time the study was complete. So those with matched physical and cognitive challenge to their actual, their functional level, They did great. They were able to maintain their cognitive level in this skilled setting. And those that were not matched showed cognitive decline in even a short period of time. This is pretty wild. 08:09 - SCREENING FOR COGNITIVE IMPAIRMENTS So some big takeaways here. Are we screening? Are we screening cognition in our older adults? The research says that the sooner we can screen people, the better chance we have to change their life and help them maintain their cognitive function and sometimes actually improve their cognitive function. There is a mountain of research that shows exercise is beneficial for cognition, especially if we're pushing into the fitness realm. and we're pushing people at high intensity and we're asking them to lift heavy things, we're asking them to learn new novel tasks. So we want to make sure we're doing that with older adults, not only for their physical function, but for their cognitive function. But we need to get a baseline of where they are to make sure that we're scaling these things appropriately. The tool that was used in this study was a mini mental state exam, which unfortunately is not great at screening for mild cognitive impairment, which is kind of that first phase before there is problems with activities of daily living, like once we get into more advanced forms of dementia. Tools like the MOCA, the Montreal Cognitive assessment may be more appropriate for catching signs of mild cognitive impairment. Also the SLUMS, the St. Louis University Mental State Exam. However, with that one, it's good to be aware that that can trigger automatically a local referral once it is complete. So you want to make sure that your patient, if there's any family members involved with care, that they're all aware that that will happen. And if this is like, man, I am not comfortable with this cognition stuff, this feels like way out of my depth, that's fine. You don't have to be the expert on everything, but you do need to be accountable to having resources in your area. Who is the SLPs, maybe outpatient, Or on your team if you are in a skilled environment that you can send for a cog referral. Or OTs, we have lots of OTs that are great at screening and intervening cognition and giving you an idea how many step commands, what type of environment, what type of cues are appropriate for this patient. but we have got to meet them where they are for cognition, just like we do for our physical interventions. So if you're not screening, start there. We've got to do more than alert and oriented times three. We've got to be getting these screening tools in use, or we've got to start making those referrals to people that are able to help get a baseline and make sure that our interventions are appropriate. So if you are screening, awesome, you are ahead of the curve. So now your job is to make sure that these interventions are appropriate, just like we're outlined in this study. 14:09 - SCALING UP OR DOWN BASED ON COGNITIVE PROCESSING DELAYS So what we want to make sure that we're doing is we want to know that there are things like cognitive processing delays, where it may take someone with more advanced dementia symptoms two minutes to process our commands. That was just five seconds of silence from me. If you can imagine two minutes of silence after your cues made this mistake so many times with this population. In two minutes, we've said a thousand things. and they're still processing the first thing that we said. So want to be mindful as we pick up on these symptoms. Cognitive processing delays can be up to two minutes. More mild forms, it could be five, 10, 15 seconds. It may feel a little more natural. Likely your skin's going to crawl, but it may be a very appropriate communication. It's going to look way different in this population. We want to make sure that the more advanced the cognitive impairment is, the more familiar the tools and the exercise interventions that we're using. We can't give a 40 point intervention and biomechanical explanation on a beautiful trap bar deadlift with an older adult. who has advanced dementia, we may be better off to use their purse and add some stuff to it, or add just grocery bags with food in it, and just ask them, pick this up. Once they do that, let's walk, walk 20 feet, or walk over to this area of the gym. No more cues, no more instruction, set it down. That may be a very skilled, very appropriate set of cues for an older adult with advanced dementia. So we want to keep in mind the tools. We also want to keep in mind the scenario. Can we control the environment? That is a skilled scaling tool. How loud is it? How busy is the environment? Is there lots of interaction? Are we at prime time in the clinic, out in a busy clinic where there's people throwing balls on a rebounder or the music's blaring? There's lots of laughter and fun. That may be a completely overstimulating environment for someone who has more advanced dementia. So the complexity… of the environment, the amount of noise, background noise, all those things are scaling options. So if we start in that quiet environment, we may eventually scale in to more advanced and complex environments where there are more distractions, where it is more like real life. But that's gotta be an intentional choice. That doesn't need to be an accident. We need to be very skilled with our interventions and that is part of it. How we choose to practice is also very important. Are we going to do random practice where we're jumping between tasks to task? That's going to be way less on the ability for someone with more advanced cognitive impairments. We may need to do block practice where we spend a big chunk of time, maybe 15 minutes, working just on a sit to stand. We may never get to a squat with a bar. That's fine. But if we can make it practical, we can meet people where we are, that may be where we need to stay. 15 minutes here, 15 minutes on the next thing, that may be our whole session. Or maybe it's something like a simple obstacle course. Pick this up, carry this, and follow me. That could be it. So I wanna keep these things in mind. If we are screening, we are getting a sense of what the cognitive ability level is of our clients, then our job is to scale it appropriately, and then you guessed it, then progress it as we're able. So we wanna use all those leveraging tools. So my advice to you, we're gonna switch gears, so that should be relevant to everyone. Now, if you are training in a group setting, kind of like this study outlines, where you're in a skilled facility, and you're doing group training, you can start with this lowest common denominator approach, but what you have to add in are easy scaling options. You've got to think about, we've kept everyone safe, but then for those that have the cognitive ability to do more advanced balance, or they're safe to do more advanced strength training, What can we do to scale it up for those individuals? So we've got everyone moving, everyone's safe. Now, how do we scale it up? Go heavier. Have heavier weight options available. Maybe instead of sitting, those people that have more advanced functional and cognitive impairments, they're going to be standing. Or maybe they're doing a dynamic movement. Maybe we're going to add some type of vestibular component where we're going to ask them to fixate and move their head side to side or up and down with the fixation point or maybe without a fixation point. Maybe we're having them close their eyes and head turn side to side or up and down. We can add that vestibular layer. We can add a cognitive component as well where we can ask preference questions like everyone, someone shout out, you can think to yourself or shout out loud some of your favorite foods. or name as many states as you can, or name things that are green. We can go very simple up to more complex counting tasks where maybe we're subtracting by 7 from 300 for someone that has a very mild cognitive impairment. Those things may still be on the docket. Those still may be very appropriate. But if we're doing group training, we can start with that lowest common denominator and then just offer scale up options. Another easy one that was even outlined in this study that they found to be beneficial was even just having a little piece of compliant foam for those that were already doing standing. Everyone in the group was mostly doing standing. They added the compliant foam in and that was a great option to scale up balance training. Everyone's getting instruction on the same movement, but there's not really a whole lot of extra instruction to change the surface. All right team, I got super fired up about this. Treated lots of people with cognitive impairments. If you're treating this population, I would love to hear any tips and tricks. Drop those in the comments. Thoughts? I will be dropping the article citation for you. The study was a new approach to individualized physical activity interventions for individuals with dementia. Cluster analysis based on physical and cognitive performance. I hope you enjoyed it. I hope you have a wonderful rest of your day and we will catch you next time. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to PTOnIce.com and scroll to the bottom of the page to sign up.
Golden Bachelor in Paradise S11E3WelcomeIntroductions of our guest co-hosts Elaine (welcome back!) and Kelsey (welcome!)Question of the Week: Have you ever participated in a talent show and what was your talent. And if you haven't, what would your talent be?Golden BachelorFeatured Ladies This Week are Joan, Ellen, and Chaos Queen Kathy (+ Theresa)Boomers gonna Boomer - Kathy-is she caring or manipulative? Teresa-clueless or devious?Rose Ceremony: Goodbye Edith and blonde lady who I have zero memory of named ChristinaWho do you think are looking the strongest right now? Will next week's Pickleball tournament be an orthopedic surgeon's dream?Bachelor in ParadiseTwo new guys on the island: Tanner and Tyler. Who immediately pull Kat and Mercedes. Will and Brayden are broken. Do they…not understand how the show works? Mercedes is Dead Eyed no more :) Tanner and Kat go for a horse ride on the beach. Mercedes and Tyler get fireworks.Chaos Creators of the Week: Sam's intestines. Girl-from me to you- get someone to send you a bottle of magnesium citrate. You are welcome. Also Aaron gets lots of boyfriend points from me.Wells advice of the week: Stop going out with girls who like other guysNo rose ceremony this week, but the ladies are in controlAre Jess and Sam's bathroom issues the most relatable vacation bummer power through situation ever?Lessons Learned
DR JAIN: Sexuality is a broad term that encompasses sexual identity, activity, attitude toward sex, intimacy, partnership, and pleasure. In this podcast, we cover the basics of sexual function and the effects of aging, medical comorbidities, and mental health on sexuality. We discuss sexual health in long-term care settings and in older adults with cognitive disorders and suggest an approach to commonly encountered sexual health issues. Welcome to The Carlat Psychiatry Podcast.This is another episode from the geriatric psychiatry team.I'm Neha Jain, an Associate professor of psychiatry, Medical Director for the Mood and Anxiety Disorders Program and Associate Program Director for the Geriatric Psychiatry Fellowship Program at the University of Connecticut Health Center, in Farmington, CT. In today's podcast, I am joined by two of my colleagues. DR COLLIER: I'm Stephanie Collier, The Editor-in-Chief of The Carlat Geriatric Psychiatry Report. DR AZIZ: and I'm Dr. Rehan Aziz, an associate professor of psychiatry and neurology at Hackensack-Meridian School of Medicine. I am also the associate program director for geriatric psychiatry and general psychiatry at Jersey Shore University Medical Center, in Neptune, New Jersey. Let's begin our discussion with the topic Dr. Jain started out with. What are your thoughts about how sexual function and sexuality intersect in older adults? DR JAIN: Yes, first it is just important to acknowledge that older adults are sexually active because discussions about sexual issues are often avoided in healthcare settings. You know there is often discomfort on part of the patient or clinician, a lack of knowledge-I mean how much training do you remember in Med School and residency. , fear of embarrassment, or ageist beliefs. However, a fulfilling sex life is a crucial aspect of quality of life for many seniors. DR COLLIER:This brings up the question of how we assess sexual health in older adults in a clinical setting. DR. JAIN: To assess sexual activity, I generally start by asking for permission to discuss sexuality with the patient. I then ask open-ended questions such as “What concerns or questions do you have in terms of your sexual activity?” I may also ask “Have you noticed changes in your sexual relationship with your partner over time?” Many older adults will not disclose sexual health issues if there are others in the room, so I try to ensure privacy when screening for sexual dysfunction. I ask about problems with libido, getting/maintaining an erection (for men), dryness or discomfort (for women), and difficulty achieving orgasm (for both). DR. AZIZ: We know that patients can be at risk of sexually transmitted diseases. Dr. Jain, what is your approach to that discussion with a patient, given that it can be a sensitive topic for many? DR. JAIN: To start the conversation, I ask whether they have concerns about their partner's sexual health. For those who are at risk, I suggest undergoing screening for sexually transmitted infections. I handle the discussion with sensitivity, using open-ended questions in a respectful yet straightforward manner, to alleviate any discomfort. This approach encourages patients to share any additional concerns they may have. And I avoid making assumptions about their sexual orientation or relationship status and allow patients to disclose their preferences at their own pace. DR COLLER: When assessing patients, it is important to examine their comorbidities as they can often affect sexuality. Dr. Jain, what is your process to assess a patient's comorbidities and their effect on sexuality? DR JAIN: Whenever I encounter patients with sexual dysfunction, I make sure to inquire about their medical history, particularly any comorbidities they may have. This is because certain illnesses like Parkinson's disease, cancer, diabetes, and coronary artery disease can contribute to sexual dysfunction. My treatment recommendations are based on the underlying causes, which may include prescribing medications such as sildenafil, referring patients to urology or sexual health counseling, or suggesting evaluation for pelvic floor physical therapy. DR. AZIZ: We know that depression and anxiety are important risk factors for sexual dysfunction, as are the medications used to treat them. SSRIs can cause hypoactive sexual desire, erectile dysfunction, and delayed ejaculation. So, when we have a patient that has sexual dysfunction and depression, or anxiety treatment should be carefully tailored. DR JAIN: I agree. Before prescribing antidepressants and during the first few follow-ups after starting a new medication, I regularly discuss potential sexual side effects. These side effects may be influenced by the dosage and can sometimes persist even after discontinuing the medication. If necessary, I may suggest taking a brief drug holiday of 24-48 hours before planned sexual activity. In some cases, I may also recommend switching to antidepressants that are less likely to cause sexual side effects, like bupropion, mirtazapine, or vortioxetine. DR COLLIER: Antipsychotics can also have negative effects on sexuality, including reduced libido, erectile dysfunction, and amenorrhea. The sexual side effects are greater in first- generation and prolactin-inducing antipsychotics like risperidone and paliperidone. Dr. Jain, what is your process for addressing antipsychotics and sexual dysfunction? DR JAIN: Yes, during the first follow-up visit after starting an antipsychotic, I usually inquire about any sexual side effects that the patient may be experiencing. If such side effects are present, I may suggest a switch to aripiprazole, which has fewer sexual side effects. Alternatively, I may recommend the use of adjuvant sildenafil to manage sexual dysfunction. DR AZIZ: It is well-known that sexual dysfunction can be affected by the aging process. As an example, women tend to have lower estrogen levels after menopause, which can lead to vulvovaginal atrophy and discomfort during sexual activity. Dr. Jain, could you please explain your approach to treating sexual dysfunction in older adults? DR JAIN: For older women who are experiencing discomfort during sex, one of my recommendations might be to use vaginal lubricants. I always encourage women to talk to their primary care physician about possible treatment options, including local and systemic hormone therapy. As for older men who are experiencing erectile and ejaculatory dysfunction, I inform them that it's a common condition. Depending on the patient's needs, we discuss how to manage modifiable risk factors like obesity, smoking, or hypertension. Additionally, I might suggest psychotherapy or a trial of a phosphodiesterase-5 inhibitor. DR AZIZ: Let's talk about treating inappropriate sexual behavior in dementia, as it can be challenging for some clinicians. DR COLLIER: This is a significant concern. Alzheimer's dementia often causes a lack of interest in sexual activity, but inappropriate behaviors may also occur. Frontotemporal dementia can lead to early sexual disinhibition, while other dementias may have it in later stages. The effectiveness of psychotropic drugs for addressing inappropriate sexual behaviors is uncertain. Instead, behavioral interventions such as redirecting, distracting, and reminding are more useful. Some clinicians may opt to use jumpsuits and shirts with buttons at the back to prevent exposure, but they should weigh the risks and benefits before doing so. DR AZIZ: Yes, treatment can be difficult. If behavioral interventions fail to reduce inappropriate sexual behaviors, case studies suggest the use of antidepressants, particularly SSRIs, and antipsychotics. There is limited evidence for the effectiveness of mood stabilizers, antihypertensives, and cimetidine. While anti-androgens (cyproterone acetate) and progestins (medroxyprogesterone) may be considered by clinicians, they are rarely prescribed due to ethical concerns when treating patients who cannot provide informed consent. DR JAIN:DR COLLIER: Shall we delve into the various limitations on sexuality in older adults? One prime example is the importance of providing quality care to patients experiencing sexual dysfunction. However, barriers to healthy sexual expression in long-term care settings can hinder both treatment and sexuality. DR AZIZ: It's a significant problem. Multiple obstacles prevent healthy sexual expression in long-term care environments, such as staff bias (i.e., labeling sexual behaviors as "inappropriate"), insufficient privacy, the practice of separating couples upon admission to long- term care, concerns regarding consent and capacity, and discrimination against LGBTQ individuals. DR JAIN: There are some ways we can prevent these restrictions. For instance, by providing risk and capacity assessment training, staff can gain confidence in managing sexual behaviors and creating a safe environment for residents to express their sexuality. Additionally, making changes to the environment, like offering Do Not Disturb signs and private spaces, can contribute to the long-term care residents feeling more comfortable. However, this does not completely fix the restrictions you mentioned Dr. Aziz. It's worrying to see the high levels of discrimination that LGBTQ patients face, particularly in long-term care settings. This stigma can be internalized by older adults who identify as LGBTQ, making them hesitant to discuss sexuality. Many LGBTQ adults prefer to age in place and avoid long-term care facilities due to concerns about stigma, autonomy, and potential abuse. One way to combat this stigma is through staff training and education. Clinicians can also help by avoiding assumptions about sexual preferences and using inclusive language when asking open- ended questions. They can also connect older LGBTQ adults to community resources, such as the Services and Advocacy for LGBT Elders USA website (www.sageusa.org). DR JAIN: It's important to acknowledge that sexuality remains a significant aspect of life for older adults, despite common occurrences of sexual dysfunction. Clinicians can greatly aid their patients by inquiring about their sexual health, as addressing sexual dysfunction can immensely enhance their quality of life. Treatment options like behavioral interventions, psychotherapy, and medications should be carefully molded to the needs of each patient. DR COLLIER: The newsletter clinical update is available for subscribers to read in The Carlat Geriatric Psychiatry Report. Hopefully, people will check it out. Subscribers get print issues in the mail and email notifications when new issues are available on the website. Subscriptions also come with full access to all the articles on the website and CME credits. DR AZIZ: And everything from Carlat Publishing is independently researched and produced. There's no funding from the pharmaceutical industry. DR JAIN: Yes, the newsletters and books we produce depend entirely on reader support. There are no ads and our authors don't receive industry funding. That helps us to bring you unbiased information that you can trust. DR COLLIER: And don't forget, you can now earn CME credits for listening to our podcasts. Just click the link in the description to access the CME post-test for this episode.As always, thanks for listening and have a great day!
Dr Uma Suryadevara joins Ethics Talk to discuss her article, coauthored with Drs Alex Rollo, Jeena Kar, and Mary Camp: “Should Antipsychotics' Risks Be Accepted by Clinicians on Behalf of Patients to Achieve Benefits of Mitigating Older Adults' Behavioral Symptoms in Short-Staffed Units?” Recorded July 31, 2023. Read the full article for free at JournalOfEthics.org.
Dr Badr Ratnakaran joins Ethics Talk to discuss his curation of the October 2024 issue: “Geriatric Psychiatry.” Recorded July 27, 2023. Read the full issue for free at JournalOfEthics.org.
Dr. Alex Germano // #GeriOnICE // www.ptonice.com In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult lead faculty Alex Germano as she discusses the topic of medication management in older adults. She talks about the importance of screening for inappropriate medications and what to do when such medications are found. Medication management is a crucial component of falls prevention programs, as many older adults are on medications that may not be suitable for them. Alex emphasizes the need for clinicians to assess medications as part of their overall approach to fall prevention. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 - ALEX GERMANO Good morning, everyone. Welcome to the PT on Ice daily show brought to you by the Institute of Clinical Excellence. My name is Alex Germano, a member of the older adult division. Today, what we're going to be talking about is a question that came up at our course this weekend in Falls Church, Virginia. It was about how to handle inappropriate medication, how to screen for it, and what to do after you learn that your patient's taking a quote unquote inappropriate med for an older adult. The older adult division is really finishing off 2023 strong. We have eight more course offerings this year alone. This weekend in particular we're going to have Christina out in Fountain Valley, California. We're in New Jersey next weekend and Annapolis, Maryland the first weekend of November. Additionally, you can catch us in New York, Westmont, Illinois, Chandler, North Carolina, Spring, Texas, and Portland, Maine, before 2023 closes out. So we hope to see you out there. I wanted to expand on this topic a bit more. 01:31 - MEDICATION MANAGEMENT It's all about medication management and how we encourage clinicians to look at medications and what do we do when we find an inappropriate medication. I feel really passionate about this topic and we really do As a component of our falls prevention programs, we need to be looking at meds, screening them, because a lot of our older adults are on a lot of medication that they should not be on. So, as part of the World Guidelines for Fall Prevention in Older Adults, medications are deemed as a domain that we need to assess. If you work in more acute settings, so maybe like acute care, skilled nursing facilities, home health, you likely have to do some sort of medication screening. You're asking about meds, they're in a system, the system or the EMR that you use actually may flag inappropriate medications already. I've heard that in the home health world that some of the it's more of the medication interactions that are being flagged versus like type of medication that we should be weary of. But if you're in outpatient settings, you may ask about medication intake on eval. but you might just write that down and then that's it. Even my, um, uh, EMR that I use and I'm working in an outpatient on wheel setting is just, you put in the meds and that's it. There's no followup. The system doesn't help me in any way. It's kind of on, on, it's my responsibility rather to perform some type of medication reconciliation, look at the meds, make sure they're on the appropriate ones. Okay. Now, if we have older adults on our caseload, we can't just ask about medications. We really need to double check some of these meds because they can have a huge impact on our patient's physical function, their lives. And it's absolutely part of our scope of practice because these medications can impact our patient's balance, their fatigue, their overall physical function and exercise tolerance. So it's definitely worth it to get familiar with some of these classes of medications. Older adults, it's important to know one, why is this a problem? 04:23 - IMPACT OF MEDICATION ON PATIENTS Older adults handle medications differently. There's a few changes that occur with age. We have an increase in body fat and a decrease in our total body water, and this could change the half-life of certain drugs. The clearance of the drugs through the hepatic system or the renal system, so liver or kidneys, also changes as a result of age, and then if you have a disease process on top of it, that will affect medication clearance. Okay, so drugs aren't being, are not leaving our patients' bodies as well, so we often see higher levels of drugs circulating systemically, which could cause negative side effects. Now, it's not really our role to decide if my patient's hepatic function or renal function is appropriate for a certain medication. And, you know, that's not our job. We are trusting the medical providers out there prescribing medications and, you know, deciding what our patient needs and at what dosage. But I argue as people and I'm sorry, as medical providers who spend a lot more time with patients, we have a unique opportunity to visualize the impact of medications that affect our patients functionally. We have the ability to see our patients for many hours after they start using a medication, whereas doctors may not see them until months away. They might not be asking about the new medication until months after. They might not have a follow-up for a while. I mean, the current state of our medical system is that many people aren't even seeing their doctors for months and months in between. So if the patient isn't tolerating the medication or if we find that the medication isn't working for their lifestyle, and I'll explain that in a minute, we are the perfect provider to alert the other medical providers on the team about this situation. So first, how do we even know that a medication is inappropriate? What are we screening for? We will link and the Instagram post of the American Geriatric Society beers criteria. Okay. They have a 2023 edition that is available to be viewed. Usually we were seeing that the free one was like a few years back, but now the 2023 version is free and open access. We recommend becoming familiar with these classes of medications so that if they appear on your patient's medication list, you know that you are going to have kind of a red flag in your mind that you're going to want to monitor for any symptoms and really define if this medication is appropriate for the patient. This document organizes medications considered to be inappropriate for older adults or those with certain diseases. They organize medications that should be used with caution, any other potential drug interactions, or medications that need to be adjusted based on renal function. Again, not entirely our scope, but we will be aware because if we see symptoms in our patient, we're going to want to report that. It also gives you a rationale for use with each medication class. That's very helpful when you go to talk with the prescribing physician because it's important to give a rationale or to cite this criteria in order to kind of get them listening and get them to really take you seriously when you go to report a medication issue. 08:43 MEDICATION INTAKE CHALLENGES Now it's not only important to screen the type of medication, but it's very important to screen how your patient takes their medication. This seems really the, I always say it seems dumb. It's really not dumb. It's very important, but you really wouldn't know how many issues there are with medication intake unless you were watching your patient take a lot of meds, which lucky for me, when I work in people's homes, I see a lot of things. Okay. Do, does your patient just use the pill bottle to pour out into their hand every morning to take their meds? Do they use a pill container? Do they use pill packs, which are those things that you can, um, order where all of their medication comes in like a nifty pack. They just rip it open and take it. It's great to ask your patient or their caregiver the current way that they take medications. And to ask if there's any barriers to that medication intake, again, I have a ton of privilege being in people's homes, seeing the way they take meds, and you'd be surprised how many people have barriers to taking medication. It could be cognitive, where they have to take medication three times a day, and they are used to only taking it once a day, or once at the end of the day. All right, hopefully we're back. I lost you for a second. And if your patient has to take medications more than once a day, that is going to increase the risk that something goes wrong. And if your patient happens to nap through med time, they miss a dose in the middle of the day, they don't have anyone there to remind them of that, that can also cause many problems. Some of our patients have difficulty with dexterity and their ability to pour medicines out from the pill container and into their hand and getting all of those small pills from their hand to their mouth. That's why you might find medication or pills kind of all over. Sorry, I'm going to ditch Instagram at this time. That's why you might find medications kind of all over the floor when you get to their house. They're having trouble getting small pills from their hand to their mouth. There's also many people that struggle maintaining, managing their meds and getting their pill containers to be filled appropriately. This is all great to screen for because these are all problems, physical therapy, but more so occupational therapy can help with. Occupational therapists are who I've personally leaned on to help with some of these dexterity problems, equipment problems, cognition issues, just because their scope of practice is a lot bigger and they are really experts at med management. So say now you have identified a problem medication. For example, my patient was given Xanax, which is a common benzodiazepine for daily management of high blood pressure. That is a super strange recommendation immediately caused a red flag in my mind because I know benzodiazepines are not supposed to be used for the beers criteria, but I connected the patient's past medical history with problems with this med. This patient has vestibular implications. has peripheral neuropathy and clinical levels of frailty so he's already quite weak and very unsteady so adding on a medication that increases false risk could be really dangerous now what i didn't do was i i didn't immediately call the doctor and complain about this prescription i let them i let the patient see if I let the patient trial the Xanax. He really was interested in doing so because the doctor said so, but I remained on high alert, monitoring for symptoms. They thought that because he had a lot of anxiety that the medication or Xanax would decrease his anxiety and drop his blood pressure. We didn't see a big change in blood pressure on subsequent visits. And he started to tell me really how woozy he felt in the morning and how he felt more very, very tired throughout the day after taking the medication. This is exactly when it's time for us to step in. Some of our patients may be on contraindicated meds and they may also feel fine and have no symptoms. They've taken them for years. They don't have a problem. If they're on a contraindicated med, however, it's just important we try to see if they have any concerning symptoms or just continuously ask or check in about them. So do they have fatigue or dizziness? At this point, we want to communicate with the prescribing physician regarding our concerns. I have sent letters with my patients to their doctor's appointments because sometimes it's hard to connect with the doctor. But I very often just call in to the nursing line to discuss the medication use. I let them know what I'm seeing in terms of symptoms and some of how the medication may be interacting between my patient's lifestyle. and the symptoms they have and their physical function. And then I kind of align that all with the recommendation based on the beer's criteria. I always cite it, like I said before, because it can just give you more power in this space. I have never, this is again, very personal, but I've never been met with a doctor that was not interested in exploring a different medication choice, or just at least talking through the symptoms and at least coming to a consensus of why the medication is appropriate for now. Many times the doctor is very willing to change or remove the medication. I think it's all about our approach here and not coming off a little too hot. We just have to come off with curiosity and just asking about, you know, just relaying symptoms, relaying data, relaying a rationale. And oftentimes I'm met with a really good response from the doctors. Now, it would also be wise to make some community connections with a local pharmacist or somebody who can help your patient with general medication questions, dosing questions, or if they're interested in getting a medication reconciliation. You may have to do some work to discover what pharmacists in the area offer. There may be virtual services available for certain patient populations. I'm thinking like the VA, for example, has some resources. There may also be private pharmacists helping with this. But again, this is very specific to your community. I would probably try to connect with that like small local pharmacy. Those folks are going to be great at having the time and the willingness to dive into medication reconciliations with your patients. So really, in summary, let's start leaning into our role as advocates for our patients' medication intake. If anything new gets added, or if your patient's been on medication for decades, it's part of our role to screen for symptoms of these meds, especially if they're on that inappropriate list for older adults. We can check on how our patient is able to take meds, see any barriers to taking medication. Remember, less doses per day is better for this population. Make sure we have people to communicate these problems with, that we get comfortable being advocates with physicians, that we get comfortable making connections with pharmacists in the area, so that we have a place to refer our patients if necessary. Getting patients off certain medications or getting them changed to a better medication well tolerated by older adults can truly have impacts on their life and function far more than any resistance training that we can give them. Deadlifts are definitely life changing, but if you can get off a scary medication that's making you feel dizzy and unsteady, then that can be far more powerful. So think about leaning into that space and we look forward to hearing how it goes. See you next Wednesday. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. 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