Annual Report

EXECUTIVE SUMMARY

The Donald W. Reynolds Department of Geriatrics in the College of Medicine at the University of Arkansas for Medical Sciences (UAMS)

• Is the only academic program at UAMS and in the state of Arkansas ranked in the Top 10 (#9) by U.S. News & World Report;
• Was ranked 36th this year in Geriatrics care by U.S. News & World Report, out of the top 203 in the nation, narrowed from more than 6,000 hospitals nationwide;
• Has expanded the number of geriatricians through recruitment and training. The department currently has six new fellows in our Geriatric Fellowship program;
• Is one of the largest clinical programs on the UAMS campus and receives high marks on customer satisfaction surveys. Growth in patient numbers has been exceptional;
• Is currently ranked #3, behind University of Wisconsin and Loma Linda University School of Medicine and ahead of Harvard (#5), in NIH awards to medical schools. The department has experienced growth in grant support to over $60 million in the past five years. The National Institute on Aging of the National Institutes of Health is the leading provider of funding on the UAMS campus;
• Maintains a strong commitment to the state of Arkansas at large and embraces the mandate “to improve the health of every older Arkansan, no matter where they live.” With support from the Tobacco Settlement (Initiated Act 1) and the Administration on Aging, A Center of Excellence in Geriatrics will be established in each of the seven Area Health Education Center (AHEC) sites across the state. Every major community in the state has a hospital that is establishing a senior health center. These centers will have a great impact on the health of older persons living in rural settings, will provide unique research opportunities, and will serve as a model for novel approaches to healthcare nationwide.

Administrative Structure

A strong Executive Committee for the Donald W. Reynolds Department of Geriatrics has been developed. This group meets twice monthly and works as a cohesive team. Each member of the Committee is responsible for managing his or her own division, assuring continued success despite rapid growth. The Executive Committee is empowered and plays a critical role in assisting the Department Chairman, Dr. Lipschitz, with decision-making, resource allocation, recruitment, and future development. The members of the Executive Committee are as follows:

KEY ACCOMPLISHMENTS

A. BUILDING THE RESEARCH ENTERPRISE

Summary of Research Activities
The research program of the Donald W. Reynolds Department of Geriatrics has seen significant growth in the past year. Total support for research of core faculty is currently $60.8 million as of June 2003, a 24% increase from FY02. Of this $60 million total, 51% is from NIH, 41% from industry or other grantors, and 8% from the VA.

Twenty new grants have been awarded this past year to our research faculty. Highlights of the year include a five year $6.6 million competing renewal of Dr. Sue Griffin's PO1 grant, “Early Events in Alzheimer Pathogenesis” and the new $5.1 milion PO1 to Dr. Robert J.S. Reis from the NIH.

Total Number of Journal Articles Published

Research scientists in the Donald W. Reynolds Department of Geriatrics frequently publish the results of their research in a variety of scientific journals nationwide. These accomplished researchers regularly share their findings and collaborate with other scientists in the field, both on and off campus.

For the fiscal year 2002-2003, a total of 112 articles were published in various journals, including articles in the following in “top tier” journals:

Core Faculty – New Research Grants, FY 02-03

Funded Faculty and Programs

The Reynolds Department of Geriatrics has developed a number of research foci concerned primarily with studying the causes of age-related dependency (cognitive loss or physical disabilities). These research efforts may be summarized as follows:

Cellular and Molecular Biology of Aging

• Sue T. Griffin, PhD, (Director of Basic Research) leads a large group of scientists studying the basic biology of Alzheimer's disease (AD). Her group has pioneered research on the role of inflammation in the development of AD. She has also identified a number of genes that are critically important in this disorder. This past year Dr. Griffin's NIA-sponsored project, “Early Events in Alzheimer's Pathogenesis” was renewed for $6.6 million over 5 years.
• Steven W. Barger, PhD, is a cellular neurobiologist who has focused largely on Alzheimer's disease. He has an ongoing NIH grant to elaborate on his original discoveries about the biological actions of beta-amyloid precursor protein (beta-APP), a gene product that has been connected to Alzheimer's by both biochemistry and by genetics. Beta-APP is the source of the beta-amyloid peptide that accumulates to form plaques in the Alzheimer brain. However, Dr. Barger has found that other processed derivatives of beta-APP prevalent in normal conditions are neuroprotective. In contrast, Alzheimer's disease is associated with an alternative processing that creates derivatives that—on the balance—harm neurons through activation of localized brain inflammation. The mechanistic details of this neurotoxicity have formed the basis of a U.S. patent, a contract awarded to Dr. Barger by Guilford Pharmaceuticals, and a book chapter in a volume devoted to the biology and pathobiology of glial cells. Dr. Barger leads a related project on Dr. Sue Griffin's Program Project Grant, aimed at providing molecular explanations for the relationship of inflammatory agents to Alzheimer's disease; this work includes collaborations with Paul Drew, Ph.D., in the Department of Anatomy. Dr. Barger was recently awarded Biomedical Research Foundation funds to study a different aspect of Alzheimer's disease: the clearance of beta-amyloid peptide from the brain, potentially mediated by a drug transporter in blood vessels. Finally, Dr. Barger continues to explore very basic aspects of gene regulation, focusing on specific transcription factor proteins that appear to play unique roles in neurons. This last project has formed the basis of three manuscripts and an application for an NIH R01, currently under review.
• Esther E. Dupont-Versteegden, PhD , a muscle physiologist, has been studying age-related changes in skeletal muscle mass and muscle stem cells. In the past she has received funding from the American Federation for Aging Research and from the NIA to look at different intracellular pathways involved in age-related loss of muscle mass and the recovery from muscle atrophy after a period of disuse. Dr. Dupont-Versteegden is also part of a collaborative study, funded by the NIH, with Drs. Peterson, Fluckey ( Geriatrics ) and Gaddy-Kurten (Physiology). In this study the effectiveness of a resistance exercise protocol is being tested under disuse conditions, similar to bed rest. Dr. Dupont-Versteegden received funding from the American Heart Association to study the transplantation of skeletal muscle stem cells into heart muscle after a cardiac infarction and is collaborating with Drs. Richard Kennedy and Russell Melchert from the Pharmaceutical Sciences department on this project. Recently, Drs Kennedy, Melchert and Dupont-Versteegden in collaboration with Dr. Jacob Joseph (Cardiology) have received a NHBLI R21 to study the effects of transplantation of genetically engineered myoblasts into infarcted cardiac tissue.
• Beata Lecka-Czernik, PhD , is studying the role of adipogenesis and age-related alterations in fat metabolism in osteoporosis. Dr. Lecka-Czernik received funding from the National Institutes of Health (NIH) for a researcher-initiated (R01) grant proposal to study the role of a key enzyme (PPR- g ) in the formation of osteoblasts.
• Yuekui Li, PhD Dr. Yuekui Li, using a microglial-neuronal coculture model, has demonstrated that a neuronal-glial interaction mediated by IL-1 directly affects the neuronal acetylcholine system. In the past year, he continued his work on understanding glial-neuronal interactions and mechanisms involved in regulation of microglial activation, which are important steps toward identification of therapeutic targets and potential development of treatment strategies for neurodegenerative conditions.
• Joan McEwen, PhD , is studying the effects of aging on mitochondria in yeast and other organisms. Dr. McEwen's research concerns mechanistic links between mitochondrial metabolism and cellular oxidative and nitrosative stress. Her work is supported by a Department of Veterans Affairs Merit Review Award (“Role of Mitochondrial Metabolism in Histoplasma capsulatum Virulence,” 1999-2004). A new grant (“Mitochondrial Respiration, Oxidative Damage, and Aging”) is one of the projects of the recently funded P01 application (P.I.: Robert J. S. Reis).
• Charlotte Peterson, PhD , a muscle molecular biologist, is following up on her pivotal finding that the stem cells in muscles that normally repair muscle damage tend to turn into fat-like cells with age. This phenomenon may contribute to frailty and the increased fat content in muscle in the elderly. This research is funded by an NIH grant to extend this work into humans in collaboration with Drs. Todd Trappe and Marjorie Beggs also from the Department of Geriatrics . Meanwhile, Dr. Peterson has joined forces with her colleagues Drs. Beata Lecka-Czernik, William J. Evans, and W. Sue T. Griffin, who specialize in studying bones, the benefits of exercise, and Alzheimer's disease, respectively, to investigate whether there are common factors at work in muscle loss, bone loss, and even memory loss - and if the same genes contribute to all three problems of aging. The ongoing clinical research study will determine if variation in the genes that control the inflammatory response and confer risk to Alzheimer's disease, also predict a tendency to frailty. These projects utilize state-of-the-art technology called DNA Microarrays to study large numbers of genes simultaneously. Dr. Peterson is director of the UAMS Microarray Facility, housed in the COA. In another project funded by the NIH, Dr. Peterson is working with Dr. Gaddy, from the Department of Physiology and Drs. Esther E. Dupont-Versteegden and James Fluckey from Geriatrics , to identify mechanisms that control muscle and bone loss during disuse, specifically as it might apply to astronauts exposed to microgravity in outer space, as well as to the elderly population. These studies compliment the longstanding collaborative project between Dr. Peterson and Dr. Houle from the Department of Anatomy, on the development of interventive strategies to prevent muscle wasting following spinal cord injury.
• Robert J. S. Reis, DPhil, is studying genetic recombination in human cells to elucidate early events in the development of cancer. He was recently awarded a competitive renewal of his long-standing VA-MERIT grant to test the role of recombination in xenograft models of oncogenesis. He heads a group studying the genetics of osteoporosis in mice and humans, funded through an NIH program project grant. He also studies the nematode Caenorhabditis elegans to isolate and characterize genes governing longevity. In February of 2003, Dr. Reis began a five-year, $5.1 million Program Project grant from NIA, entitled “Metabolic Mechanisms Limiting and Protecting Longevity.”
• John Joseph Thaden, PhD , was appointed in 1999 as Assistant Professor of Geriatrics , having served previously at UAMS both as a postdoctoral fellow and as a Lecturer with Dr. Robert J.S. Reis. He is the Core Leader for the Metabolic Assessments Core of the Reis Program Project, and also directs part of the research in Project 1 of that PPG, dealing with the creation and testing of long-lived mutant strains of the nematode C. elegans , in which mutations have been placed in a constant genetic background and are then studied for effects on metabolite profiles and antioxidant defenses.
• Kodetthoor B. Udupa, PhD Research on erythroid cell stimulating factor (ESF), a factor present in the serum and involved in the proliferation of late erythroid cells, has continued over the past several years. The production of a monoclonal antibody to this factor has given a big boost to this research. This antibody not only affects the erythroid cell formation in vitro in cultures, but also suppresses erythropoietin induced erythroid cell proliferation in exhypoxic polycythemic mice. This suppression is both in a dose- as well as time-dependent manner. Hence, an inverse relationship between ESF level in the serum and erythroid cell formation exists. Purified ESF is now being sequenced and further characterized. These findings were recently presented at national meetings of the American Society of Hematology. The work is supported in part by Ortho-McNeil Pharmaceutical Corporation and Aventis Pharmaceuticals.
• Jeanne Y. Wei, M.D., Ph.D., FACC, FSGC, Professor and Executive Vice Chairman of the Reynolds Department of Geriatrics , has been studying cardiovascular disease and aging, both in the laboratory and at the bedside, for over two decades. She is interested in enhancing the current understanding of the influence of age on the heart, and why the older person is more vulnerable to poor outcomes following ischemic and hemodynamic stress. She and her research group have found that in response to acute stress, myocardial changes in terms of cell injury and death are increased, while adaptive changes including cardiac myocyte hypertrophy, protein synthesis and RNA synthesis are all decreased in the old compared to the young adult heart. There are also qualitative as well as quantitative age-associated differences in the pattern of gene expression, including that of the early response genes (e.g., c-fos). Transcription regulation is also apparently altered with aging. She is currently studying one of the major muscle transcription factors, serum response factor (SRF), on cardiac structure and function. She is also engaged in efforts to develop ways to target specific cells and/or signaling molecules in order to reduce myocardial injury and cell death in older persons in the future.

Nutrition, Metabolism, and Exercise Laboratory

The research goal of the NMEL is to investigate the combined interaction of nutrition, exercise, and aging on functional status, macronutrient metabolism, and skeletal muscle function and metabolism. The clinical research programs based in this unit have already produced important findings that are being used to train physicians, other health care professionals, and the public how to greatly delay late-life dysfunction. Studies conducted in the NMEL involve both healthy and frail elderly persons with multiple chronic diseases. The NMEL also provides expertise and facilities to develop health-promotion and disease-prevention programs.

• Bill Evans, PhD is the director of the Nutrition, Metabolism, and Exercise Laboratory in the Donald W. Reynolds Department of Geriatrics . His laboratory examines the relationship between exercise, nutrition and aging. His landmark studies have demonstrated the ability of older men and women to improve strength, fitness, and health through exercise, even into the 10th decade of life. He receives grant support from a variety of sources including the National Institutes of Health, the Veterans Administration, and NASA. His current research has demonstrated that consumption of an ad libitum, low-fat diet produces weight loss and decreased risk of diabetes with no reduction in total calorie intake. His research projects are also examining the effects of diet and exercise on renal function, body composition, and muscle strength in elderly men and women with chronic renal failure. In addition, his laboratory is exploring the causes of fatigue in patients with cancer, with particular interest in anemia, muscle wasting, and deconditioning.
• Robert Coker, PhD His ongoing and future research projects are focused on the therapeutic influence of exercise training and/or dietary modification on the pathogenesis of insulin resistance in humans.
• Jim Fluckey, PhD , has focused on mechanisms of muscle protein turnover (plasticity), and how these mechanisms may be affected by age (sarcopenia) and/or muscle disuse (accelerated muscle atrophy). He is currently working on grants that are exploring muscle cellular signal transduction for the initiation of protein synthesis and degradation after resistance type exercises in both human and rodent models. Dr. Fluckey has an NIH K0l grant entitled “Aging and Mechanisms of Human Protein Synthesis.” This project is funded for 5 years.
• Nicholas Hays, PhD is currently supported by a NIH National Research Service Award to examine metabolic adaptation to changing macronutrient intake in elderly people. He is examining the rate of de novo lipogenesis (new synthesis of fat) in response to a high carbohydrate diet with and without exercise.
• Patrick Kortebein, MD , the newest member of the NMEL, is a physiatrist with a primary appointment in the Department of Physical Medicine and Rehabilitation. He joins the UAMS faculty August 2003 and will direct research on the adaptations made by elderly people to current and novel rehabilitation strategies.
• Charles Lambert, PhD, is examining the role of testosterone and resistance training in hypogonadal elderly men. He is also involved in research to examine the etiology of fatigue among cancer patients receiving chemotherapy. He recently submitted an RO1 NIH application to examine the mechanism of action of the popular Atkins' diet in elderly men and women.
• Dennis Sullivan, MD, serves as principal investigator for applied clinical research initiatives of the NMEL and focuses on nutrition, muscle metabolism, and functional approach to the delivery of nutritional and rehabilitative care to frail, institutionalized elderly persons, and to maintain optimal health in the non-frail elderly. For the past 15 years, he has been funded to study the interrelationship between nutrition, physical fitness, and illness in the frail elderly. The results of this research have been published in numerous journals.
• Todd Trappe, PhD , continues to focus on the interactive effects of aging, disuse, and exercise, which has been supported by two NIH grants (a K01 and R21 award). He is also collaborating with Dr. Charlotte Peterson on two projects looking at the molecular basis of an individual's adaptation to resistance exercise and the molecular basis of the change in muscle quality that occurs with aging. He has also completed a project with the European Space Agency at the MEDES bed rest facility in Toulouse, France. This study examined the effectiveness of a resistance training program and device for the International Space Station. Individuals were studied while undergoing simulated microgravity (-6° head down tilt) for 90 days. His research has also focused on changes in the rate of muscle protein synthesis and degradation following exercise. These projects have been completed in conjunction with Dr. Trappe's mentoring of a PhD and a Masters student in the Department of Physiology, both of whom graduated in the spring of 2003. Dr. Trappe has been and continues to mentor an additional PhD student from Physiology and teaches two lectures in the Medical Physiology course.

Cognitive Impairment Research

• Cornelia Beck, PhD, RN, FAAN , heads a group of researchers examining the role of disruptive behaviors in dementia and strategies for improving best practices in long-term-care settings. In addition, the UAMS Alzheimer's Disease Center, established by a major grant from the NIH in 2001, is directed by Dr. Beck and co-directed by Sue Griffin, PhD. Other faculty from the Donald W. Reynolds Department of Geriatrics play key roles, as well. The Center includes an Administrative Core, Clinical Core, Neuropathology Core, and Education Core. Like other Alzheimer's Disease Centers nationwide, the UAMS center brings together scientists, physicians, and other health care professionals dedicated to finding causes and effective treatments for Alzheimer's disease and related disorders. The Alzheimer's Disease Center seeks to assist qualified scientists by providing clinical data from healthy volunteers and older participants with dementia, as well as postmortem tissues and other biological specimens. The Center also provides pilot funding for research into Alzheimer's disease and related disorders.
• John Hart, MD , has demonstrated that semantic memory recall can be mediated by synchronizing 30 Hz brain rhythms that are modulated by the thalamus and connect the different memory systems in the brain (published last year in Proceedings of the National Academy of Science). These studies provided the first proposed neural mechanism of how semantic memory is mediated, with exciting clinical applications since semantic memory deficits typically present as word finding problems. Word finding difficulties are not only common in normal aging, but present in degenerative neurologic diseases (e.g., Alzheimer's disease), schizophrenia, closed head injury, epilepsy, and stroke. Over the past year, Dr. Hart has extended his work in how the nervous system encodes semantic memory (memory for concepts and knowledge) in several patient populations. He has begun to set up his electrophysiology laboratory to detect semantic memory deficits and continues to perform fMRI studies of semantic memory. He has conducted extensive clinical applications of semantic memory on patients with Alzheimer's disease, Mild Cognitive Impairment, schizophrenia, and Post-Traumatic Stress Disorder. He plans to apply for funding over the next 1-2 year period to perform more detailed clinical assessments of memory in several of these patient populations. In addition, Dr. Hart's lab is also exploring drug trials for improving semantic memory based on the theory of memory they have developed and drugs that affect that circuitry.
• Victor Henderson, MD , received funding from the national Alzheimer's Association to evaluate memory changes during normal aging in a well-defined population of middle-age women in Melbourne, Australia. One important goal of this international collaboration is to determine whether common genetic variations, including variations related to hormones like estrogen, might play a role in memory loss that affects nearly everyone during “normal” aging. Important findings have already emerged, including the demonstration that memory skills are well maintained during the woman's transition through the menopause and the finding that serum cholesterol levels during midlife are related to memory performance. Research conducted by Drs. Hogervorst and Henderson under Administration on Aging funding has identified factors associated with memory in a healthy population in rural Arkansas. Educational attainment is significantly linked to memory during middle age and old age. Although there are racial differences in memory scores, this disparity is largely explained by differences in education. Interestingly, women in this rural setting are able to learn and remember better than men even though they tend to have received less education than men.
• Sandy Pope, PhD , is in her second year of her five-year grant from the National Institute on Aging, totaling more than $622,000. Her research project is “Dietary & Genetic Risk Factors for Cognitive Decline.” She is also in year 2 of her $100,000 grant from the Alzheimer's Association to examine additional antioxidant genotypes. For both of these studies, she is examining a cohort of over 3,000 African American and Caucasian older adults, aged 70-79 years at baseline, enrolled in the Healthy Aging and Body Composition (Health ABC) study. Dr. Pope received funding from the Chancellor's Circle for over $13,000 to collaborate with Dr. Sue Griffin and examine inflammatory genotypes and cognitive decline in a subgroup of the Health ABC cohort. Recently Dr. Pope received funding from a private donor to organize a Conference on Complementary and Alternative Medicine (CAM) to Prevent and Treat Alzheimer's Disease.

Research Collaborations On and Off Campus

Alzheimer's Disease Center
Four Dementia Pilot Projects were approved by NIA and funded in 2002-2003. The four funded projects are listed below.

Pilot 1: Automated Cognitive Assessment of Persons with Alzheimer's Disease ($17,800)
John J. Chelonis, PhD (PI), Assistant Professor, Department of Psychology, College of Arts, Humanities and Social Sciences, UALR
Merle Paule, PhD (Co-PI), Head, Behavioral Toxicology Laboratory, Division of Neurotoxicology, National Center for Toxicological Research

Pilot 2: Determination of the Role of CPE-mediated mRNA Translational Control in Alzheimer's Disease Pathology ($17,800)
Melanie C. MacNicol, PhD, Assistant Professor, Department of Anatomy and Neuroscience, College of Medicine, UAMS

Pilot 3: Effects of Acetylcholinesterase Inhibitors on Semantic Memory in Mild Alzheimer's Disease ($13,800)
John Hart, Jr., MD, Associate Professor, Departments of Geriatrics , Neurology, and Radiology, College of Medicine, UAMS

Pilot 4: Effects of Hearing Loss and Amplification on Auditory/Verbal Tests for Alzheimer's Disease ($10,600)
Laura Smith-Olinde, PhD, CC/A, FAAA, Assistant Professor, Department of Audiology and Speech Pathology, College of Professional Studies, UALR and College of Health Related Profession, UAMS

Center of Geriatric Nursing Excellence:
University of Arkansas for Medical Sciences College of Nursing

The John A. Hartford Center of Nursing Excellence is one of five funded centers in the country to implement innovative programs in geriatric nursing education, practice and research with an emphasis on leadership and interdisciplinary collaboration. Under the direction of Claudia Beverly, PhD, RN, FAAN, the HCGNE has been involved with the Arkansas Aging Initiative, the Donald W. Reynolds Center on Aging, and other providers of services to the older population. The HCGNE strives to improve the quality of life for all older adults and their families and communities to meet their individual needs, hopes and expectations.

The HCGNE collaborates with clinical partners to enhance an integrated model of care for the elderly. This work requires leadership and communication skills to facilitate change in organizations and also to work with a variety of collaborators. Having the geriatric expertise at the UAMS College of Nursing and the Reynolds Center on Aging allows us to draw from a talented group of individuals to accomplish this goal.

Practice Initiatives:
A major initiative of the HCGNE is the Falls Prevention Best Practices that is being implemented in the Reynolds Senior Health Center. Through the leadership of Hope Hartz, APN and the clinic director, Jerry Malott, MD, we are working to implement the Falls Prevention Guidelines. We were successful in a collaborative partnership with the Area Agency on Aging, Southwest to secure $150,000 in funding from the Robert Wood Johnson Foundation for an eighteen-month grant to develop an integrated model of health care and social service delivery. With leadership from the HCGNE, we assisted with development of a strong community partnership and serve as evaluators for the project.

Education Initiatives:
Two education initiatives were implemented by the HCGNE during fiscal year 2003. The first was the implementation of a Gero-psychiatric theory and clinical course in Summer 2002. This course provides the Geriatric Nurse Practitioner students beginning knowledge and skills to build competencies in Gero-psychiatric nursing.

The second was the Southern Geriatric Nursing Certificate Program (SGNCP) that is designed to prepare nursing faculty from the Southern Region in geriatric nursing, Web-based course design and delivery. This program is funded for $750,000 by the Department of Health and Human Services Health Resource and Services Administration (HRSA) and resulted from the efforts of the HCGNE leadership. Thus far, twenty faculty from across the southeastern region have participated. Implementation of this program is expected to have a dramatic impact on the inclusion of gerontology in undergraduate nursing programs in the South.

Research Initiatives:
Dr. Pao Tsai has completed two years as a Hartford Faculty Research Scholar. Her success includes being named a John A. Hartford Post Doc, Co-investigator on a VA HSR&D funded grant, submission of two other grants, and several published journal articles and presentations. During this time frame, two faculty members from outside the state, Dr. Lazelle Benefield and Dr. Cathy Cole were awarded John A. Hartford Post Docs and will study with Dr. Cornelia Beck and Dr. Kathy Richards. One John A. Hartford Pre-Doc was awarded to Gwynn Davis who is enrolled in the doctoral program at UAMS and will study with Dr. Claudia Beverly.

Dr. Sunghee Tak has been selected as the recipient of the 2003 Summer Faculty Fellowship and the Faculty Scholar beginning Fall 2003. Dr. Tak will be working on the development of a proposal for a P20 pilot study titled “ Effect of Individualized Computer Activity on Sleep and Depression among Arthritic Women in Assisted Living.” Her mentor will be Dr. Cornelia Beck.

The second Summer Grant Writing Institute was offered June 24-26, 2002 with 19 participants from six states in the southern region. Evaluations were good ranging from 5.0-4.1. Our third summer Geriatric Nursing Proposal Development Workshop has changed focus from that of developing research skills to the development of skills necessary to successfully develop program proposals and obtain funding. Seven participants representing nursing programs from seven states in the southern region will participate in the weeklong workshop July 29-August 1, 2003. The planning committee, led by Cornelia Beck, PhD, RN, decided to extend the workshop from three days to five so that participants will be able to more effectively complete their work on submitted proposals and gain assistance from the faculty during the workshop.

The HCGNE continues to sponsor bi-monthly Geriatric Grand Rounds in collaboration with the Reynolds Department of Geriatrics . Presenters included Robyn Stone, PhD, Executive Director of the Institute for the Future of Aging Services and Patricia Archbold, DNSc, RN, FAAN, Director, John A. Hartford Center of Excellence in Geriatric Nursing from Oregon Health and Science University.

Administrative Team:
We are pleased to announce that Sandie A. Lubin, MA, RN, is joining the HCGNE staff as Project Administrator. Sandie has an extensive background in nursing and has particular strengths in the area of communication. Erwin Hall, BBA, has also joined our administrative team as Program/Project Specialist and will assist in the evaluation process of several important projects.

OUTREACH PROGRAMS

Arkansas Aging Initiative

The Arkansas Aging Initiative (AAI) is a program of the UAMS Donald W. Reynolds Center on Aging, in partnership with the UAMS AHEC program, local/regional hospitals, Area Agencies on Aging, local colleges and universities, and local communities. The mission of the AAI is to improve health outcomes of older Arkansans through interdisciplinary clinical care and innovative education programs, and to influence health policy at the state and national levels with emphasis on care of rural older adults. The aim of the AAI is to create a network of seven Centers on Aging (COAs) statewide to improve the quality of life for older adults and their families. Each COA, located in an AHEC region, provides programming for the entire region, and includes an administrative component, an education component, and a clinical component.

Administrative
The AAI Central Leadership Team consists of Claudia J. Beverly, RN, PhD, FAAN, Director; Robin McAtee, RN, MHSA, Associate Director; Ronni Chernoff, RD, PhD, FADA, Statewide Director of Education, and Gwynn V. Davis, MNSc, RN, Statewide Education Coordinator. This team plays a central role in coordinating and developing the regional programs which includes assisting the local/regional hospital in establishing the clinical component of the program, designing and implementing the education program, and fulfilling the necessary evaluation and reporting task to the Arkansas Tobacco Commission, the legislators, and the Governor.

Education
The regionalized educational programs include: continuing education offerings in geriatrics for health care professionals in the area; educational opportunities for students in the health care disciplines, including medical students, physicians in training, geriatric nurse practitioners, nurses, pharmacists, and social workers; educational programs for older adults and their families; and education of the community, in general. An Education Advisory Committee has been formed for five of the regional COAs that assists the education director to establish and manage the education programs.

Senior Health Clinics
The Senior Health Clinics (SHC) are developed, managed, owned, and operated by the local or regional hospital. These clinical programs provide a continuum of care from the outpatient to the nursing home setting. Once a Senior Health Clinic has been developed, the major focus of the program is to improve the health of older persons through 1) more accessible care, and 2) the interdisciplinary team approach to health.

Regional COA Progress to Date
Schmieding Center for Senior Health and Education (SCSHE):
Established January 1, 1999, SCSHE was the first satellite COA of RCOA. It is a unique partnership between UAMS, AHEC Northwest, the Schmieding Foundation, and Northwest Health System. Located in Springdale, SCHSE serves the older adult population of Northwest Arkansas. The Director of SCSHE is Larry Wright, MD, and the Associate Director/Director of Education is Beth Vaughan-Wrobel, EdD, RN. On April 9, 2002, a formal ceremony was held to announce the grand opening of a 27,500 square foot facility to house both the education and clinical programs. This facility and its programs were made possible through a generous donation of $15 million from Lawrence H. Schmieding, CEO, of Schmieding Foundation and President of H.C. Schmieding Produce. Patient care services of SCSHE include four Senior Health Clinics, owned and managed by Northwest Health System, which offer a continuum of care – clinic, hospital, nursing home and rehabilitation. During 2002, the Center recorded 11,325 patient visits, opened a Memory Disorder Clinic, and opened its rehabilitation center, which includes a therapeutic pool. During 2002, SCSHE offered 17 caregiver training classes with 129 graduates, provided 657 caregiver consultations, provided rotations for 36 academic health professional students, offered 31 continuing education programs with 411 attendees, and offered 141 community education programs with 2,486 attendees.

Because the donation from the Schmieding Foundation supports the above activities, the tobacco dollars for this area are being used to open three outreach programs located in Harrison, Bella Vista, and Mountain Home. An interim education director has been hired part-time for the Mt. Home site to begin July 2003. The other two sites are in various stages of operation. The outreach program in Harrison is located at the AHEC-NW Harrison. Deanne Couey, MSN, RN is the Coordinator of Education for this site. Through December 31, 2002, 32 senior caregiver classes were offered at 7 Senior Centers to 369 attendees. These classes were co-sponsored by the Area Agency on Aging of Northwest Arkansas (AAA NW). Four programs were offered to health professionals during the fall of 2002 to 114 attendees. The Bella Vista/Rogers Outreach program began operation Fall 2002. Sherry White, RN, serves as the Coordinator of Education. This site will be located in Bella Vista at the Senior Resource Center (an area shared by several non-profit organizations) once renovation is completed in the Fall 2003. The Family Caregiver Workshop, co-sponsored with the AAANW was offered at local churches in Bella Vista, Fayetteville, and Springdale. An Education Support Group for the Visually Impaired was started fall of 2003. The first two meetings were so successful (27 attendees and 47 attendees) that other education groups for the visually impaired will soon be started in Washington County.

South Arkansas Center on Aging (SACOA):
SACOA, the second satellite COA, began operations July 1, 2001. The endeavor is supported through a partnership with UAMS, AHEC South Arkansas, Medical Center of South Arkansas, and the City of El Dorado. To date, 4,149 patient visits have been recorded. Allen Pirnique, MD, is the COA Director and Kathy Packard, BA, LSW is the Education Director. Over 60 education programs have been offered with over 1,651 participants. The community advisory committee in this area has helped to raise over $800,000 during the first 2 years and more recently has added $24,500 to that total.

Texarkana Regional Center on Aging (TRCOA):
Located in Southwest Arkansas, TRCOA was developed through a partnership between UAMS, AHEC Southwest, and CHRISTUS St. Michaels Healthcare System. Development of the COA progressed very quickly since the Senior Health Center component was already operational through CSMHS. Jerry Stringfellow, MD, is the COA Director, and Amy Leigh Overton-McCoy, APN, is the Director of Education. Both assumed these positions June 1, 2002. The grand opening for TRCOA was held July 23, 2002. To date, educational programming is being offered in each of the 10 counties in TRCOA's service area. Additionally, $27,700 has been obtained from various pharmaceutical companies as unrestricted educational grants.

Center on Aging Northeast (COA Northeast):
COA Northeast, located in Jonesboro, began operations in its renovated education space March 15, 2002. The Senior Health Clinic was renovated and opened August 2002. Doug Maglothin, MD, is the COA Director and Beverly Parker, RN, BSN, MS, is the Education Director. SHC manager, Terry Weaver, MD, was recruited as their first geriatrician and began August 2002. In early 2003 a Memory Disorder Clinic with a local neuropsychologist was started. This COA was the first COA to participate in geriatric video teleconference programming through the Arkansas Geriatric Education Center (AGEC) in Little Rock. They have also recently obtained Approved Provider status from the Arkansas Nurses Association to provide nursing CE, and continue to increase outreach education efforts to other counties in the region. Additionally, COA Northeast is in the very initial stages of its development campaign to build a new state-of-the-art facility to house the education program and the Senior Health Clinic within the next three to five years.

Delta :
Located dually in West Memphis and Helena, this COA is in the development stage. Focus for the Senior Health Clinic component has been shifted to West Memphis. Preliminary discussions with the local hospital began in September 2002. The education component is in the initial phase with a new resource room located in Crittendon County Memorial Hospital. Terri Williams, RN, MS, began as the Education Director in January 2003. The Delta AHEC provides a part-time education coordinator, Dodie Danehower, from its Helena office.

South Central Center on Aging (SCCOA):
SCCOA is located in Pine Bluff and moved to its new location on I-530 in May 2003. Theresa Horton, APN, was hired as the Education Director and assumed this role August 1, 2002. SCCOA began offering educational programming during the fall of 2002. Dr. Dale Terrell, a geriatrician, has been recruited for the new Senior Health Clinic and will be on location in July 2003. Plans for an October 8, 2003 grand opening are in progress.

West Region:
Located in Fort Smith, this COA is in the development stage. Dr. B.J. Landis was named Transition Coordinator in July 2002. Due to the community having two hospitals that want to own and operate SHCs, the RCOA will hire a doctorally qualified individual to be the Director who will also fulfill the role of the education director. Sparks Regional Medical has recently hired a geriatrician who will start in September 2003, and St. Edwards Regional Hospital is recruiting. This COA is expected to be operational late in 2003.

Evaluation
During 2002-2003, with input from the Central Leadership Team, the evaluation team completed the Education Outcomes Evaluation Protocol to evaluate the education programs developed and implemented at each COA. This protocol received approval from the UAMS Human Research Advisory Committee during 2002, and data collection began at SACOA, SCSHE, TRCOA and COA Northeast and during 2003, data collection began at SCCOA, Fort Smith and the Arkansas Delta. The central leadership team has also worked closely with the RAND Corporation (hired by the Tobacco Commission to evaluate all of the tobacco funded programs) to develop indicators and gather data for an overall program evaluation of the AAI over the past 2 years. This evaluation will continue with quarterly data collection and reports.

Community Needs Assessments
The community needs assessments in all seven regions have been completed. Plans are to generate a composite report to summarize, compare, and contrast the overall findings across individuals, counties, and regions and to complete a needs assessment of Pulaski County.

B. ADVANCING MEDICAL AND GRADUATE EDUCATION

Departmental Support for Curriculum Innovations / Improvements

• Annual Education Retreat for Teaching Faculty
• Monthly Education Committee Meetings
• Quarterly Education Subcommittee Meetings
• Monthly Department Faculty Meetings
• Monthly Department Executive Committee Meetings
• Online Geriatrics Education Modules for Geriatrics Clerkship students
  (first and only clerkship to utilize this method of teaching) – Operational modules include: Hormone Replacement Therapy, Falls, Urinary Incontinence, Infections in the Elderly, Normal Aging, and Geriatric Pharmacotherapy. Modules in progress include Osteoporosis, Dementia / Delirium, Depression, and Geriatric Assessment.
• Observed Structured Clinical Exam (OSCE) for Geriatrics Clerkship student assessment (first and only clerkship to utilize this method of assessment)
• 12 successful Elder/Student luncheons which brought elderly community members and junior medical students together in an informal environment for lunch and discussion
• Monetary award ($500) offered to the exceptional senior medical student for “demonstrated superior humanistic qualities and an outstanding appreciation of Geriatrics ” during the junior-year Geriatrics Clerkship

GME Initiatives

• Incorporation of the ACGME 6 General Competencies into the Geriatrics Fellowship curriculum
• Biweekly standardized Nursing Home instruction
• Weekly NLR VA Research Conferences
• Increased research opportunities for fellows
• Implementation of the 360 o evaluation process for fellows
• Collaboration with the Department of Psychiatry to develop a one-year Geropsychiatry Fellowship

Medical and Graduate Education Program Accomplishments

• Improved Geriatrics Clerkship now entering its 6 th year of operation - overall satisfaction rate of 96 % for 2002-2003 academic year
• Collaboration with satellite Center on Aging programs to increase education for medical trainees in rural areas through weekly broadcasts of Geriatric Grand Rounds
• Senior Selective in Geriatric Primary Care, Long Term Care, and House Calls
• Complementary and Alternative Medicine course now housed under the Department of Geriatrics – 15 students for 2002-2003 and 17 registered for 2003-2004
• Four "Red Sash Awards" for teaching excellence from the COM 2003 graduating class: David Lipschitz, MD, PhD; Cathey Powers, MD; Reed Thompson, MD; and Ann Riggs, MD
• Retained 1 of 5 2002-2003 graduating fellows for Department staff position
• Retained 1 of 5 2002-2003 fellows for a two-year position in the VA Specialized Fellowship Program in Advanced Geriatrics
• Retained 1 of 5 2002-03 fellows for a second-year fellowship position to develop and pursue an academic career
• Recruited 6 fellows for the 2003-2004 academic year. One will be in collaboration with the Hematology-Oncology division. This individual will complete a one-year Geriatrics fellowship followed by a Hematology–Oncology fellowship in order to become a certified Geriatric Oncologist.
• Residency Review Committee (RRC) site visit for fellowship accreditation in June 2003; results pending.

Center on Aging Education Committee
The Reynolds Center on Aging Education Committee (RCOAEC) met monthly during 2002-2003. This committee serves as the advisory committee for the Arkansas Geriatric Education Center (AGEC). Established in July 1999, the AGEC has been the impetus for an expansion of existing continuing education programs, as well as the genesis of new programs that expand the educational reach of the RCOA. The AGEC is funded through the Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services. It is directed by Ronni Chernoff, PhD, RD, FADA who is also Associate Director for Education of the CAVHS GRECC, Director of Education for the RCOA, and Director of Education for the Arkansas Aging Initiative. The AGEC was renewed in 2002 for five years beginning July 1; the total award is $2,100,000.

Continuing Education for Health Professionals
Since its establishment, the AGEC has produced 19 video teleconferences on a variety of topics. In 2002-2003, topics included Falls and Falls Prevention; Dementia:Diagnosis; Incontinence in Older Adults (co-sponsored with the Kansas GEC); Dementia:Management; and, Smoking Cessation, Air Quality, and Policy. The video teleconferences are broadcast throughout Arkansas and to sites in Kansas, Louisiana, and Tennessee via the VA bridge, to the AHECs, the Rural Hospital Network, and independent receiver sites located at community colleges, branches of the University of Arkansas, VA hospitals, and other sites. All of the live broadcasts are taped and edited and will be available for continuing education credits with post-tests and evaluations on-line sometime in 2003.

The GRECC, the AGEC, and the RCOA sponsored or co-sponsored 3 symposia during the past year:

• Nutrition and Aging XVII: Nutritional Syndromes in Older Adults
• Geriatric Medicine Update: Cancer Management of Older Adults
• Best Practices in the Continuum of Care: Patient Safety Issues

During this year, over 570 health professionals have attended video teleconferences, and approximately 400 health professionals have attended CE seminars. Attendees come to these programs from all over the United States. We have provided approximately 8000 hours of continuing education for practicing health professionals and students in the health professions.

In winter, 2002, a statewide evaluation survey was conducted and over 1200 surveys were sent out. The responses have been very helpful in planning the upcoming year's programs.

Geriatrics Training for Health Professionals
A continuing need during 2002-2003 has been to train staff who work in the new satellite centers on aging that are funded through the tobacco settlement and are part of the Arkansas Aging Initiative. In the 2002-2003 year, we offered a self-paced, self-study program - the Arkansas Geriatric Education Mentors and Scholars (AR-GEMS). At the end of 2002-2003 we had 60 enrollees who were health care practitioners representing a variety of health care disciplines, including medicine, nursing, social work, physical therapy, dietetics, and pharmacy. Participants included representatives from Jonesboro, El Dorado and Texarkana, where new Centers on Aging have been opened. A training session is scheduled for the fall and spring of 2003-2004. The AR-GEMS curriculum has been awarded 105 contact hours from the Arkansas Nurses Association for continuing education. Other professions have given 88 hours and applications are underway for continuing education credits for other health professionals.

The AR-GEMS faculty-training program, called the Summer Institute, was launched in the summer of 2001 and has been extremely successful. Training was offered during summer, 2002 and summer, 2003.

The AGEC newsletter, Vision, has published 16 issues since its inception in July 1999. The mailing list started at 500 and has increased to nearly 2000. During 2002-2003, we expanded it from 2 to 4 pages. The Web site ( www.agec.org ) has had over 12,000 hits. During 2002-2003, a health promotion, on-line training for medical residents was completed and is presently available for use. We also developed, pilot-tested, and offered a geriatrics curriculum to the general surgery residents. This project will be a recurring training. Enduring materials, including PowerPoint slides, scripted narration, and PDA-downloadable reference tables are in preparation.

Geriatrics Training for Students
The Reynolds Center on Aging Education Committee has developed two interdisciplinary courses, Death & Dying and Communicating with Older Adults. Death & Dying was not offered in 2002 due to the unavailability of course directors, but will be offered again in the spring of 2004. Communicating with Older Adults was offered in the fall of 2002 and will be subscribed to again in the spring, 2004.

A Kids Into Health Careers program was launched with 114 students participating in a MASH tour of the Reynolds Center on Aging and other experiences.

Future Plans
The RCOA and the AGEC, in collaboration with the GRECC, expect to accomplish the following during the coming year:

• Broadcast four video teleconferences
• Have 20 video tapes available with on-line CE post-tests and evaluation forms
• Register 25 participants in AR-GEMS training for health practitioners
• Register five faculty AR-GEMS participants
• Train practitioners from satellite Centers on Aging
• Develop a geriatric dental curriculum for practicing dental health professionals
• Develop a physician version of AR-GEMS
• Collaborate with partners Arkansas State University and the Community Health Centers of Arkansas on educational projects
• Develop a Kids into Health Careers experience in outreach sites
• Add a new AR-GEMS module on Incontinence
• Complete an AR-GEMS curriculum for non-degree health professionals
  

C. CLINICAL IMPROVEMENTS

Summary of Clinical Operations/Improvements

• The Reynolds Senior Health Center was the site of more than 19,000 clinic visits this year.
• Geriatrics faculty staff eleven nursing homes and four transitional care units.
• Dr. Reed Thompson leads the hospice and palliative care program and also serves as Medical Director for Arkansas Hospice.
• The HouseCalls Program, directed by Delbra R. Caradine, MD, was established in spring 2000 to provide in-home visits by a geriatrician to individuals who are unable to come to the clinic for care. Beginning in 2002, Randy Jones, APN, joined this program full-time. This program has experienced a 51% increase in patient visits this year.
• New clinical faculty include Burcu Ozdemir, MD; Monisha Medhi, MD, Jeannette Shorey, MD; Linda Beuscher, APN; Ran Zhou, APN; Kathleen Rutherford, APN; and Erin Williams, PhD.

Patient Visits by Clinical program

Reynolds Senior Health Center

During the academic year the SHC has continued to grow in volume of visits with an 18% increase from FY02. Additional services include nutritional assessments and counseling; pharmacy consultations; and geriatric social assessments, resources acquisition and dementia education for patients and caregivers by two full-time social workers.

Progress/Innovations/QA/CQI

• The Reynolds Senior Health Center was selected for a site review by Joint Commission in Oct. 02 to examine the handling of medical records, and received a very favorable response.
• A new method of routing forms requiring provider signatures was implemented. One person now manages these forms and obtains the signatures. The timely handling of these forms has improved considerably.
• Practice guidelines for MD/APN teams to develop consistency in management of the ten most common diagnoses are being developed.
• In Jan. 2003, new clinic schedules were started to ensure that an MD/APN collaborative team was scheduled in the clinic to better consult on their panel of patients. This has been successful in improving the communication between members of the team.
• In the fall of 2002, 1300 influenza vaccinations were administered.
• The SHC has been successful in decreasing the new appointment waiting time from two months to two weeks.
• The patient satisfaction survey performed in Aug 2002 showed improvement from 73.6% to 93.8% in patients' recommending the clinic to family and friends.
  

Division of Long Term Care (DLTC)

 Under the leadership of Ann Riggs, MD, the DLTC continues to expand and develop all of its programs. The division continues to focus on four areas: clinical services to nursing homes in both transitional care units (TCU) and long term care (LTC) domains (APN & MD collaborative practices); teaching clinical medicine within the LTC setting; medical directorship; and policy and quality improvement within LTC.

Long Term Care
The Division currently serves 11 local nursing homes. Southridge Nursing Home and Rehabilitation Center, a rural community nursing home located 50 miles from Little Rock in the town of Heber Springs, was added this year. These 11 nursing homes represent a mixture of Medicaid, private, and proprietary homes, and seven of the 12 homes also have Medicare dual certification. Three of the facilities recently had outstanding annual surveys by the Office of Long Term Care.

The long-term care census has fluctuated, but overall continues to run around 500. Actual visits have increased by 33% over the past year. Due to the rapid growth and responsibilities for care of the Medicare Units, two physician and APN teams were added to accommodate these services. Monisha Medhi, MD, and Olive Phillips, APN, serve as the Little Rock Medicare team. The North Little Rock Team consists of Burcu Ozdemir, MD, and Mary Trentham, APN. Each team spends 50% of their time in the TCU's. The long-term care MDs include Dr. Tom Benton, Dr. Jennifer Co, Dr. Jerry Malott, and Dr. Ann Riggs. These physicians spend 30-50% of their time in the LTC setting and are involved in patient care, medical directorship, and the teaching of medical students, residents and fellows. Four APNs (Drexel Jordan, Hope Hartz, Riesa Gusewelle, and Linda Beuscher) spend 50% of their time in the LTC setting. Their primary responsibilities include direct patient care and teaching Geriatric Advance Practice nursing students. This year, additional administrative support was added. Shelia Meabon-Brooks, RN, joined the team to provide phone triage and inservices for nursing staff within the facilities. Pam Elton, who handles our scheduling and support services for billing, also gives inservices to the CNA staff of the facilities served.

Sub-Acute and Transitional Care
Patients discharged from the hospital after three-day stays qualify for Medicare services within the nursing homes. Patients who need further skilled care as a result of deconditioning, orthopedic surgery, an acute neurologic event, or continued need for IV therapy or wound care qualify for up to 100 days of subacute care. Patients are eligible for physical therapy, occupational therapy, and speech therapy services, as well as more intensive nursing services than the long-term care custodial residents. Seven of the nursing homes served are certified for Medicare services. These homes include Beverly North, Lakewood Plaza, Woodland Hills, Chenal Health and Rehab, Robinson, Southridge, and Northridge. Patients are admitted from UAMS, Baptist Health System, and St. Vincent Infirmary Medical Center, as well as from out-of-state transfers. The Medicare services have increased substantially, and our APN coverage has expanded to develop a North Little Rock and a Little Rock team. As noted above, TCU services were separated from LTC services to accommodate the increase in services, and Little Rock and North Little Rock Medicare teams were developed.

Medical Directorship
The DLTC provides medical directors to nine of the 11 nursing homes. The DLTC has medical directorships at Beverly North, Lakewood Plaza Nursing Center, Robinson Nursing Home, Rivercrest, Woodland Heights Rehabilitation and Nursing Center, Chenal Health and Rehab, Southwest Homes, Northridge, and Southridge in Heber Springs. In addition, Dr. Riggs assumed Medical Directorship of the Parkview Medicare Unit on June 1, 2003. Our physicians take a very active role in the Quality Assurance programs at the nursing homes as part of their medical director responsibilities. They are also responsible for general oversight of medical care within nursing homes and transitional care units.

We continue to provide the primary leadership for the Arkansas chapter of the American Medical Directors Association. Dr. Malott, serves as president of this chapter, and Dr. Riggs serves as secretary/treasurer. The chapter held one fall conference and one spring conference this year. The topics of this year's meeting focused on risk management and legal issues in LTC.

Dr. Riggs, Dr. Malott, and Dr. Dennis Sullivan were invited speakers to the National American Medical Directors Association meeting. They presented a half-day seminar on Risk Management of high-risk areas, such as pressure sores, nutritional frailty, and restraints.

All physicians in the LTC division are required to be credentialed through the national AMDA program as certified medical directors (CMD). Dr. Malott, Dr. Riggs, and Dr. Benton are certified and Dr. Co is currently working on her certification.

Other News of the LTC Division

The interdisciplinary group that includes the Office of Long Term Care, Arkansas Health Care Association, and UAMS physicians continued to develop process indicators to improve delivery of care in nursing homes. This group recently completed process indicators in documentation and management of behavioral disturbances, falls, and restraints used in nursing homes. Formal training and implementation started July 2002.

Dr. Riggs continues to consult for the Arkansas Foundation for Medical Care LTC CMS initiative. The CMS public reporting of nursing home quality indicators started in October 2002. Regional workshops have been held in restraints, pressure sores, and pain management. Twenty-one pilot homes have been chosen for CMS-sponsored intensive training in these areas, as well as Quality Assurance training. Each home will participate in the program for three years to determine if intensive training in the areas of Quality Assurance and Quality Measures impacts care-delivery within these homes.

Dr. Riggs gave the keynote talk to introduce the initiative of pain management at the Arkansas National Health Advisory Group in March 2003. Dr. Riggs also gave the keynote talk to the Arkansas Gerontologic Society on “End of Life Issues in the Nursing Home” in April 2003.

HouseCall Program
The HouseCall Program (HCP) provides quality, cost-effective medical services to homebound persons who are unable to visit a doctor's office without a great deal of difficulty, and enhances the patient's quality of life and ability to live independently longer, limiting or delaying the utilization of hospitals and/or nursing homes. The HCP provides medical care in the patient's own environment, which allows them to live autonomously and helps them to fulfill their desire to live and die with dignity.

Although the HCP remains in great demand, it is not financially sound. Thus, in addition to directing this program, Dr. Caradine also serves as Medical Director of the Arkansas Hospice's Little Rock division. The other staff members remain full-time in the program. We are investigating ways to improve the cash flow including the option of performing minor dermatological procedures in the home. Our total patient numbers have increased by just over 50% in the past year. However, since we often care for the most frail and the sickest at the end of life, our numbers are volatile and do not reflect the labor intensity of the job.

Our APN, Coordinator, and Physician meet weekly to discuss patient concerns, as well as both patient and staff needs that should be addressed by the healthcare system in general. During these meetings, we also schedule times for service providers to inform us of what they can provide to our patient population. In addition to this weekly meeting, the Physician and APN meet regularly to collaborate on patient care and address any other concerns.

Progress, Innovations, QA, CQI, and Areas of Excellence

• Family Medicine residents and Pharmacy students continue to observe in the HCP and we continue to receive positive feedback.
• As a member of the UAMS Teaching Scholars program, Delbra Caradine, MD, (HCP Director) is developing a block rotation for senior medical students, and Family Medicine and Internal Medicine residents.
• Dr. Caradine served as a preceptor for a sophomore medical student, as well as a senior medical student who took the rotation as a primary elective and is considering pursuing Geropsychology with an interest in caring for the homebound patient.
• The HCP has a loose association with the UAMS undergraduate-nursing program. Over 30 nursing students spent time with HCP patients through weekly home visits. They primarily reported to their preceptors, but kept the HCP informed of any changes or problems with the patients.

The HCP continues to participate in health fairs, address civic groups, and represent the University in the community by providing quality, cost-effective care to the underserved patient and those elderly who have problems accessing the healthcare system. HCP staff are currently developing a HouseCall Teaching Program for students and residents and are seeking a Medicare waiver for a Social Worker to give support in this area of dire need. 

Palliative Care Service

The Palliative Care Service (PCS) remains an integral part of the Donald W. Reynolds Department of Geriatrics and is directed by Reed Thompson, M.D. The PCS continues to be involved in the overall mission of the Donald W. Reynolds Department of Geriatrics in service, education, and research in the area of end-of-life care.

Palliative Care Service Clinical Program

The PCS clinical program has stabilized at the maximum workload that can be handled with the existing staff. Services in palliative care are offered at the Arkansas Cancer Research Center and the Central Arkansas Veterans Healthcare System. A more formalized Palliative Care Service with an interdisciplinary team at the University Hospital has been recommended to the administration of University Hospital.

Dr. Reed Thompson continues to provide the medical director to The Arkansas Hospice by way of a contractual agreement. The Arkansas Hospice provides central Arkansas with outpatient and inpatient hospice services. Two inpatient facilities are open in central Arkansas with a total of 40 beds. Occupancy rate has consistently been at 100% with a waiting list.

Palliative Care Education

The Palliative Care Education program continues as a part of the third-year medical student Geriatrics Clerkship. Dr. James Bridges, instructor and second-year Geriatrics Fellow, was given one half of the medical student teaching load, the other half being presented by Dr. Reed Thompson. Dr. Bridges did an outstanding job as instructor in this setting. The Palliative Care curriculum continues to receive high evaluations from the students.

The College of Medicine's one-month elective for fourth-year medical students in Palliative Care had three medical students this year. Two of these students expressed a strong interest in Geriatrics as a career in medicine.

First-year Internal Medicine Residents receive clinical experience in palliative care during their four-week Geriatrics rotation. They attend a VA Palliative Care Clinic one-half day/week. They are given didactic instruction and patient exposure in the Palliative Care Clinic.

DWR Geriatrics Fellows each spend one month in a clinical one-on-one setting with Dr. Thompson on the PCS. They are exposed to end-of-life care in several venues: outpatient clinics, home visits, hospital consults, and an inpatient hospice facility.

Hematology/Oncology Fellows at UAMS spend a one-month clinical one-on-one with Dr. Thompson on the PCS. These fellows also participate in end-of-life care in the different venues.

Dr. James Bridges will finish his year as a Palliative Care Fellow in the DWR Department of Geriatrics June 30, 2003. He has accepted a position in Nashville, TN in a large non-profit hospice with an affiliation with Vanderbilt University. 

Palliative Care Research

A grant to study post-mastectomy lymphedema, a common complication of breast cancer treatment, submitted to the National Institutes of Health in November 2001, but not funded, has been sent to the Komen Foundation for consideration. The grant application has been reduced to a pilot clinical study that falls within the Komen foundation guidelines for funding. The basic science aspect of the NIH grant proposal will be submitted to the Arkansas Breast Cancer Program Committee this summer. Private donors at the ACRC have pledged money to the lymphedema research project if matching funds can been found from foundations or other granting agencies.

A grant application has been submitted to the Arkansas Cancer Coalition for seed money to develop and evaluate a clinical end-of-life curriculum that will be offered to healthcare providers at the regional Centers on Aging in Arkansas.

D. PROFESSIONAL HONORS, 2002-2003

Steve Barger, Ph.D.

• Appointed member, Committee on Animals in Research, Society for Neurosocience, 2002-present
• President-Elect, Arkansas Chapter of the Society for Neuroscience, 2002-2003
• Scientific Board of Directors, Integrated Neurobiology, San Francisco CA, 2002-present
• Editorial Board, Journal of Neuroscience Research, 2002-present

Cornelia Beck, Ph.D.

• 2003: National Gerontological Nursing Association Board of Directors Lifetime Achievement Award
  

Claudia Beverly, Ph.D.

• May 2003 Leadership In Health Policy Award, College of Nursing Alumni
• 1998 – Present Robert Wood Johnson Nurse Executive Fellowship
  

Delbra Caradine, M.D.

• Editor, American Academy of Home Care Physicians newsletter
• Board member on the American Academy of Home Care Physician (AAHCP)
• Medical Director, Arkansas Hospice Inpatient Unit, Little Rock, Arkansas
• Assistant Medical Director, Arkansas Hospice
• Board member, Arkansas Hospice
• Member, DHS Long Term Care Advisory Board
• Case presentation at the AGS/AAHCP annual conference, May 2003
• Chairman, planning committee for the 2004 AAHCP annual meeting
• UAMS Teaching Scholar
  

Robert Coker, Ph.D.

• 2003-present Member, Human Research Advisory Committee
• 2003-present Veterans Administration Eligibility Status
• 2003-present Veterans Administration Research and Development Committee
  

Bill Evans, Ph.D.

• Editorial Board, The Journal of Clinical Endocrinology and Metabolism, 2001-2004
• Member, (Chairman, 2002-2003) Dept. Of Veterans Affairs Merit Review Subcommittee for Aging and Clinical Geriatrics , 2000-2003
• Calloway Visiting Professor in Nutrition, U Cal, Berkeley, Dept. of Nutrition, 2003
• Member, Epidemiology and Disease Control III study section, NIH, 2001-2005
• Invited Speaker: 8 th Annual Congress of the European College of Sport Science, 2002
• Invited Speaker: Physical Disabilities Through the Lifespan Conference, Sponsored the NIH, Bethesda, MD, 2003
  

Jim Fluckey, Ph.D.

• Ad hoc reviewer for a National VA Merit Grant
• Reviewer for Journal of Physiology, American Journal of Physiology, Medicine and Science in Sports and Exercise, and the Journal of Applied Physiology
  

John Hart, Jr., M.D.

National Committees

• Executive Committee, Behavioral Neurology Section, American Academy of Neurology
• Secretary/Treasurer (President-elect) Behavioral Neurology Section of the American Academy of Neurology
• Chairman, Subspeciality Certification Committee, Behavioral Neurology Section, American Academy of Neurology

Editorial and Review Activities

• Editorial Board, Neurocase
• Ad Hoc Reviewer for the following journals: Annals of Neurology; Brain; Brain and Language; Cognitive Neuropsychology; Epilepsia; Journal of Cognitive Neuroscience; Journal of Neurophysiology; Journal of the International Neuropsychological Society; Lancet; Neuroimage; Neuropsychiatry, Neuropsychology, and Behavioral Neurology; Neurology; Neuropsychologia; Science
  

Victor Henderson, M.D.

Faculty Accomplishments

• Visiting Professor, Department of Psychiatry, University of Melbourne, Melbourne, Australia
• Kearney Visiting Professor, Mental Health Research Institute of Victoria, Melbourne, Australia
• Visiting Professor, Department of Neurology, Southern Illinois University, Springfield, IL
• Professorial Fellow, Department of Psychiatry, University of Melbourne
• Who's Who in America (56th edition)
• America's Top Doctors (3rd edition)

Editorial Board Memberships

• American Journal of Alzheimer's Disease
• Climacteric
• Cognitive and Behavioral Neurology
• Menopause
• Menopause Management
• Menopause Review

Ad hoc Reviewer

• American Journal of Alzheimer's Disease
• American Journal of Mental Retardation
• Climacteric
• CNS Drugs
• JAMA (Journal of the American Medical Association)
• Journal of Speech, Language, and Hearing Research
• Menopause
• Neurology
• Neuropsychiatry, Neuropsychology, and Behavioral Neurology
• New England Journal of Medicine

NIH study sections

• NIA Special Emphasis Panels

Scientific Advisory Boards

• International Scientific Advisory Board, French Foundation for Alzheimer Research
• External Consultants Committee, NIH Women's Health Initiative Memory Study
• Advisory Board, National Aphasia Association
• Initial Review Board of the Medical and Scientific Advisory Council, Alzheimer's Association
• Lawrence C. McHenry Awards Subcommittee, American Academy of Neurology
• Hormone Therapy Advisory Panel, North American Menopause Society
• Scientific Advisory Board, Alexander Foundation for Women's Health Planning Committee, Graylyn Conference on Women's Cognitive Health
• Scientific Committee, 2nd European Consensus Conference on Menopause
• Scientific Advisory Committee, 5 th International Symposium on Women's Health and Menopause (Lorenzini Medical Science Foundation and the NIH NHLBI)
• Scientific Program Committee and Abstract Review Committee, North American Menopause Society

Leadership in National Professional Organizations

• Board of Trustees, North American Menopause Society
• Executive Committee, Section on Geriatric Neurology, American Academy of Neurology
• Chair Elect, Section on History, American Academy of Neurology
  

Pham Liem, M.D.

• America's Top Doctors, Castle Connolly Guide. 2000-2003
  

David A. Lipschitz, M.D., Ph.D.

• Telly Award, 2002 for Aging Successfully with Dr. David television series.
• Videographer Award 2002 for Aging Successfully with Doctor David 203
• National Mature Media Awards, 2002, for Aging Successfully with Doctor David 213, and Doctor David 214.
• Finalist for Freddie Award, 2002.
• Arkansas Cultural Enrichment Award, 2003
• Red Sash Award for teaching excellence from the College of Medicine 2003 graduating class
  

Charlotte A. Peterson, Ph.D.

Society memberships and elected offices

• Sigma Xi
• AAAS
• Researchers against Inactivity-related Disorders (RID)
• Elected Organizer of the 2003 FASEB Conference on “Muscle Stem Cells”

Study Sections

• NSF External Grant Reviewer, 1992 - present
• Chair, NIH Program Project Site Visit Review Teams, 1996-present:
• “Mechanisms of Muscle Aging: Analysis and Intervention”, Nadia Rosenthal, PI, Harvard University
• “Gene Therapy Approaches to Treatment of Muscular Dystrophy”, Jeffery Chamberlain, PI, University of Michigan
• “Transgenic Models of Muscle Aging”, Charles Epstein, PI, UCSF
• “Reactive Oxygen Species: Stress and Damage in Old Muscle”, John Faulkner, PI, University of Michigan
• “Oxidative Stress, Mitochondrial Dysfunction and Aging”, John Papaconstantinou, PI, University of Texas Medical Branch, Galveston
• NIH Ad Hoc Study Section Member, Skeletal Muscle Biology, 2002

Invited Reviewer

• Development
• Developmental Biology
• Experimental Cell Research
• American Journal of Physiology
• Cell and Tissue Research
• Proc. Natl. Acad. Sci. USA
• Experimental Gerontology
  

Sandra Pope, Ph.D., M.P.H.

• 2002 Charles E. Gibbs Leadership Prize from the Jacobs Institute for Women's Health
  

Cathey Powers, M.D.

• Red Sash Award for teaching excellence from the College of Medicine 2003 graduating class
  

Robert J. S. Reis, D. Phil.

• Membership on Editorial Review Board: Calcified Tissue International: Editor for Genetics of Bone Disease, 2001 – present.
• Visiting Scientist, Southern Methodist University Dept. of Biology (11/06/02); host, Dr. William Orr. Presented: “Mapping Polygenes Affecting Longevity and Stress Resistance.”
• Visiting Scientist, Univ. of Texas at San Antonio (09/18/02); host, Dr. Jan Vijg. Presented: “Genetic Mapping of Genes Affecting Lifespan and Bone Density, from Worms to Humans.”
• Visiting Scientist, Laboratory of Molecular Growth Regulation, NICHD/NIH, Bethesda MD
  

Ann Riggs, M.D.

• Red Sash Award for teaching excellence from the College of Medicine 2003 graduating class
  

Reed Thompson, M.D.

• Red Sash Award for teaching excellence from the College of Medicine 2003 graduating class
  

Todd Trappe, Ph.D.

• Invited scientist, International Space Station Muscle Biopsy Team, National Aeronautics and Space Administration, Fall 2002 - present
• Reviewer for: American Journal of Physiology; Journal of Applied Physiology; International Journal of Sports Medicine; Medicine and Science in Sports and Exercise; Journal of Clinical Endocrinology and Metabolism
  

Jeanne Wei, M.D., Ph.D.

National and International Committees

• 2003 Chairman, Advisory Board, National Health Research Institute, Division of Gerontology, Taipei, Taiwan
• 2002-2005 Member, Public Policy Committee, The Gerontological Society of America, Washington, D.C.
• 2003-2004 Member, Executive Committee, Biological Sciences Section, Gerontological Society of America, Washington, DC

Editorial Boards

• 2002- Editorial Consultant, Nucleic Acids Research
• 2002- Editorial Consultant, Life Sciences
• 2002- Editorial Consultant, Journal of Experimental Medicine

Invited Lectures

• 2002 Invited speaker, “Calcium Homeostasis and Impaired Calcium Tolerance”, at Pivotal Research in Cardiovascular Syndromes in the Elderly II: Acute Coronary Syndromes in the Elderly: Mechanism and Management, Chicago, IL
• 2003 Invited Speaker, “Pre and Post Graduate Geriatrics Education in the USA”, at Chiba University International Symposium on the Biology of Aging, from Bench to Bedside, Chiba, Japan
• Invited Speaker, “Heart Disease in the Elderly”, at Medical Grand Rounds, Department of Medicine, Advocate Christ Medical Center and University of Illinois, Chicago, IL
• 2003 Invited Plenary Speaker, “Cardiac Function”, at “Aging and Biology: Effects on Growth and Plasticity Through the Lifespan”, Trans-NIH Conference on Physical Disabilities Through the Lifespan, National Institutes of Health, Bethesda, MD
  

Roger Williams, Ph.D.

• Vice President Elect, Arkansas Psychological Association Division of the American Psychological Association;
• Public Education Coordinator, Arkansas Psychological Association Division of the American Psychological Association
• Site Visitor, Clinical Internship Training Programs for the American Psychological Association.
  
  

E. UNIVERSITY RELATIONS

Community Relations

Chaired by Charlotte Gadberry of Little Rock, the Reynolds Center on Aging (RCOA) Community Advisory Board consists of 35 representatives from throughout the state (see Appendix V). The Board serves as the support and advisory group for the development and marketing efforts of the Reynolds Department of Geriatrics and for the RCOA. The Board's Development Committee reviews nominations for membership and strives to create a membership profile that is representative of the RCOA's constituency and one that is balanced with respect to sex, geography and ethnicity. Eleven new members joined the board in spring 2002, replacing members who had served their limit of two terms. Board member Edward Dillon of Little Rock died in March 2003 while serving his second term.

The Reynolds Department of Geriatrics and Center on Aging have raised a total of $79,208,725 since inception. There was an increase of $2,323,556 in FY 2002-03.

National Media Opportunities

The Reynolds Department of Geriatrics gained national media attention when it was ranked #9 in the nation by U.S. News & World Report in the “2004 Best Graduate Schools Edition.” In its July 2003 “America's Best Hospitals Edition,” U.S. News & World Report ranked the UAMS Medical Center's Geriatric care as #36 out of the top 203 programs in the nation, narrowed from more than 6,000 hospitals nationwide.

Dr. William Evans was featured in “Anti-Aging Secrets of Astronauts” in The Best Times of Memphis, TN, and in “Strong Bones, Strong Muscles” with Bottom Line Health. He was also invited to present the Calloway Lecture at the University of California at Berkley, where he presented “Metabolic Effects of Diet, Exercise, and Age.”

Dr. Sue T. Griffin was featured on the Discovery Channel's Website, where she gave an Alzheimer's disease update. Dr. Griffin's research was also featured on her alma mater's (University of Rochester) Website in April.

Dr. David Lipschitz introduced his new book, “Breaking the Rules of Aging,” in October 2002. National media response to the book resulted in 14 television/radio interviews at stations in Arizona, New York, New Jersey, Florida, Connecticut, California, and Wyoming, in addition to “Voice of America” affiliates. Academic Physician & Scientist featured Dr. Lipschitz in an article “Up Close and Personal with Dr. Lipschitz.” Dr. Lipschitz also appeared at book signings in major bookstores in New York, Boston, Chicago, Dallas, Palm Springs, Philadelphia, Washington, D.C., and other cities.

Local Media Opportunities

Opportunities for statewide coverage were plentiful in FY 2002-03. There were 82 articles in Little Rock and statewide newspapers and periodicals that featured RCOA. In Jonesboro and Texarkana, news coverage of Center on Aging openings was extensive by local media. During the past year, RCOA faculty and staff appeared in 130 television and radio interviews and news stories.

Other

During the year, 20 tours of RCOA were given to visiting groups and individuals. The RCOA was represented with a staffed booth at the Geriatrics Society of America meeting in Boston, MA, and at the American Society of Geriatrics in Baltimore, MD. It was also represented at a number of local health fairs and meetings. Upgrades were made to both the Reynolds Department of Geriatrics and the RCOA Websites. Professional Profile cards were developed and/or revised for each Senior Health Center interdisciplinary team member.

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