Fall 2003 Vol 1, No 2

Her “Call for Help” Defined Her Mission

When Jo Ellen Ford* walked through the door of a small, non-descript, one-story building in 1988, she was searching for help. The sign on the building indicated the programs it housed had something to do with geriatrics, a fast emerging medical field specializing in the care of older persons. Jo Ellen’s aging parents, who had shaped her life - her role models, her solid rocks - now needed her full attention as their health began to decline. Like so many children who find themselves in a situation like this one, Jo Ellen was frightened and anxious to find help. She recalls, “I walked into the building and said, ‘Can anyone here help me?’…and they did.”

The rest, as the story goes, is history – in fact, it is the history of the Reynolds Center on Aging (RCOA). The building Jo Ellen ventured into at the time housed the entire Geriatrics program in the Division of Internal Medicine at the University of Arkansas for Medical Sciences. The specialists cared for her parents, and they also provided Jo Ellen with important information about caregiving.

Jo Ellen was thankful and relieved to find the help she needed, but she began to worry about others in her situation and what services were available to them. She made improving healthcare for seniors her mission. Together with visionary Dr. David Lipschitz and his team, she helped to organize a committee of concerned individuals. This committee of leaders appealed for funding to establish a freestanding Department of Geriatrics and quickly found itself in the middle of a larger-than-life undertaking that included not only establishing a department but also building the four-story Donald W. Reynolds Center on Aging.

One person’s simple request – “Help me” – has resulted in the development of a strong program that is changing the face of healthcare for Arkansas seniors. “Being able to make a difference in the lives of so many people is what has propelled the RCOA staff and our Board,” she said. “That small structure is gone now and the massive Jackson Stephens Spine Center stands in its place, but I will always be thankful for the help I received in that tiny, one-story building at the corner of Capitol and Elm Streets. My parents always told me that ‘good things come in small packages’ and as usual, they were correct.”

*Jo Ellen Ford is one of only two life members of the Reynolds Center on Aging’s Community Advisory Board. She served as Chair of the Advisory Board for five years and currently serves as Co-Chair of the endowment campaign.

Education is Another Key Component of ADC

The UAMS Alzheimer’s Disease Center (ADC) is a multi-purpose program. When it was established at the Donald W. Reynolds Center on Aging two years ago, patient research was trumpeted as its main directive. Today, the research core is going well with more than 140 loyal participants who make annual visits for evaluation and whose results are shared with other programs nationwide. But the research core is only one facet of this effective program.

Another part of the ADC mission is centered on education for the public and professionals. Under the guidance of Elaine Souder, PhD, RN, the education core of the ADC is making presentations to groups on topics ranging from “age associated memory loss” to “strategies for family caregivers.”

Currently, the ADC and St. James Methodist Church in Little Rock co-sponsor an eight-week series for families and caregivers of elderly persons with Alzheimer’s disease or other cognitive impairment disorders. Programs are held at the church’s Markham campus (9820 W. Markham, Little Rock) from September 9 through October 28. For additional information about the series, contact Dr. Souder at (501) 296-1893.

The education core has assembled speakers from the Reynolds Center on Aging and UAMS faculty who can speak to your club, organization or association on a wide variety of topics. If you are interested in obtaining a speaker, please contact Bill Fortson at (501) 296-1338.

From the Chair

Dear Friends,

“Healthcare readily available to every Arkansan within a 50-minute radius of their front door.”

The Center on Aging South Central (COASC) in Pine Bluff moves toward accomplishing this goal by opening the fifth Center on Aging satellite! The satellite serves a 10-county area, and in a few short years this system will be available statewide.

Imagine…. after coasting slightly ahead of Mississippi in nearly every ranking, Arkansas suddenly jumps ahead with its innovative concept of geriatric healthcare! Senior Arkansans are taking steps toward a healthier future, thanks to the vision of Dr. David Lipschitz and the team he assembled. Once additional satellites open in Fort Smith and West Memphis/Helena, Arkansas will have a total of seven Center on Aging satellites.

Fort Smith has embraced the idea with open arms. In fact, the two highly competitive medical centers in that area put aside their individual agendas to join forces on the project! The Center on Aging Northwest should open in early 2004.

RCOA Board Member Martha Lambert of Helena has put her heart and soul into helping Arkansas’ Delta Region. Martha loves eastern Arkansas, and with dedicated energy continues to promote the opening of a satellite in the Delta.

To quote from “The A-Team,” a 1980s television program, “I love it when a plan comes together.” It’s all about people, and it’s about making life healthier and better for the people of Arkansas. That’s why we celebrate each time we open another Center on Aging satellite. Healthcare within a 50-mile radius of every home in Arkansas – what an incredible plan!

Charlotte Gadberry
Chair, Community Advisory Board
Donald W. Reynolds Center on Aging

P.S. Speaking of “openings,” drop by the Reynolds Center on Aging and enjoy lunch! Catering to You, one of Little Rock’s premiere caterers, is now serving lunch Monday through Friday in the RCOA’s Generations Cafe on the G-level. Serving hours are from 11 a.m. until 2 p.m., and snacks are available until 3 p.m. (You can even purchase frozen “take home” entrees!) What a delicious addition to RCOA!

Caring for the Caregiver

Caring for a person with Alzheimer’s disease can be extremely demanding, particularly if family members wish to provide the care themselves while the patient is still able to live at home. In such a situation, caring for the caregiver becomes just as important as caring for the patient.

Many times, a home caregiver is the spouse of an Alzheimer’s patient who has made a lifelong commitment to the patient and is determined to care for that person until the end. “Many of these spouses do that until they wear themselves down, and sometimes even die before the person they’re caring for. I think the number one thing that caregivers don’t do for themselves is take advantage of respite care,” said Sarah Cain-Bartlett, LCSW, Coordinator for Community Services at the Schmieding Center for Senior Health and Education of Northwest Arkansas in Springdale.

In order to maintain their own health, and to be able to give their spouses optimal care, family caregivers need relief from the demand of 24-hour care. Such relief provides a time of renewal for the caregivers, so they can continue to cope with the difficult behaviors often encountered when a loved one has dementia. In addition, when the caregivers use respite care, the family is often able to keep a loved one home for a longer period of time before admitting him or her to a long term care facility.

The Schmieding Center offers counseling and planning services, and will help caregivers locate a qualified person to provide care in the home during the caregiver’s absence. The Center also offers a series of courses that teach people the most effective ways to care for homebound patients and are open to anyone, whether they be family members caring for a loved one or career-oriented individuals.

The Elder Pals program is the Center’s initial course, upon which all other training and education is built. After completing the 25-hour course, a certified Elder Pal can aid patients, including Alzheimer’s patients, who still live at home and require minimal assistance. The Elder Pals course also offers an educational segment on Alzheimer’s disease and other forms of dementia, as well as depression. This is where family members learn about the importance of respite care for themselves, and also what to expect during the progression of Alzheimer’s disease.

“We try to explain to caregivers why people with Alzheimer’s disease do what they do,” Bartlett said. “After they have that understanding, such behavioral changes don’t create as much stress for the caregiver, and the caregiver knows how to address them.”

The Schmieding Center is a program of the Donald W. Reynolds Center on Aging, and is a partnership with the Area Health Education Center – Northwest in Fayetteville and Springdale, the Northwest Health System in Springdale, and the University of Arkansas for Medical Sciences. For more information on respite care, contact the Schmieding Center at (479) 751-3043 or access their Website at http://www.schmiedingcenter.com

Learning about Alzheimer’s Disease

The Donald W. Reynolds Center on Aging Resource Library has a wide selection of books that can help you learn about Alzheimer’s disease. In addition to the titles listed below, the Library also has several videos, and a librarian will be glad to direct you to Internet resources using one of the Library’s computers. The Library is located on the ground floor of the Center on Aging. Hours are 9 a.m. – 3 p.m., Monday through Friday.

1. Alzheimer’s Disease: A Guide for Families and Caregivers Lenore Powell, Editor
2. Alzheimer’s Disease: Unraveling the Mystery National Institutes on Aging
3. The Validation Breakthrough: Simple Techniques for Communicating with People with Alzheimer’s-Type Dementia Naomi Feil
4. Interventions for Alzheimer’s Disease: A Caregiver’s Complete Reference Ruth M. Tappen
5. Alzheimer’s: The Answers You Need Helen D. Davies and Michael P. Jensen
6. Alzheimer’s and Dementia: Questions You Have, Answers You Need Jennifer Hay
7. Alzheimer’s Early Stages Daniel Kuhn
8. Alzheimer’s Disease: Frequently Asked Questions - Making Sense of the Journey Frena Gray Davidson
9. Alzheimer’s: Finding the WordsA Communication Guide for Those Who Care Harriet Hodgson
10. The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer’s Disease, Related Dementing IIlnesses, and Memory Loss in Later Life Nancy L. Mace, MA and Peter V. Rabins, MD, MPH

Community Resources Help Alzheimer’s Patients

One of the greatest challenges for Sandy Sanders, LCSW, is to find services to help an older loved one remain at home for as long as possible. Sanders, a geriatric social worker, sees patients at the Reynolds Senior Health Center and UAMS Alzheimer’s Disease Center and is familiar with community resources throughout the state. She can assess a family’s strengths and weaknesses, along with these resources, to find those which will provide the most benefits for each patient and family.

Asked for a list of services she gives to family members, she comments, “Each family is different in the strengths they bring to the table. So determining the family’s strengths and building on those by accessing community resources that might be available is very important. Some families have excellent social support available, while others have little or no social support.” Sanders continued, “I look at neighbors, extended families and church support. I also look at financial resources.”

Sanders usually refers patients and families to their local Area Agency on Aging if there is a need for in-home services when the patient meets guidelines set by the Department of Human Services. She frequently provides forms from Alzheimer’s Arkansas Programs and Services. Alzheimer’s Arkansas has special grants to assist with legal planning, respite care, and even mental health counseling.

Here are some of the community services available for older adults Sanders uses in her counseling: (Not all services are available in every community).

• Home health aides to assist with personal care, meal preparation, light housekeeping and other light assistance, under the supervision of a licensed nurse
• Homemaker service or chore services which provide assistance with daily household activities like laundry, shopping, errands, driving and companionship
• Physical, occupational, and speech therapies provided in the home by a licensed nurse or trained specialist
• Adult day care
• Health education and wellness (Reynolds Senior Health Center Senior Outlook Series)
• Caregiver support or training (American Red Cross Caregiver Training Program, Schmieding Center Training Program in Springdale)
• Hospice Care
• Respite Care
• Home-delivered meals, available through local Area Agencies on Aging
• Senior Companion Program
• Telephone reassurance
• Transportation
• Information and referral (Area Agencies on Aging)
• Financial counseling

Support Groups Offer Way to Find Resources

While community resources for caregivers of patients with Alzheimer’s disease can be found simply by calling an agency that provides a specific program or service, often the best way to find resources is by attending a support group for caregivers. Here you can learn from other caregivers what has worked for them.

The Alzheimer’s Arkansas Programs and Services maintains a list of caregiver support groups throughout Arkansas. Here we offer a select number of groups meeting in the Greater Little Rock area.

Jacksonville Support Group
7:00 p.m., third Thursday, Rebsamen Education Building

Little Rock Support Group
7:00 p.m., second Tuesday, Alzheimer’s Arkansas Office
3:00 p.m., fourth Tuesday, Baptist Health Medical Center
7:00 p.m., fourth Tuesday, Alzheimer’s Arkansas Office
1:00 p.m., fourth Thursday, Alzheimer’s Arkansas Office

North Little Rock Support Group
2:00 p.m., third Tuesday, Baptist Health Medical Center, North Little Rock

The Reynolds Center on Aging hosts a spring and fall Early Stage Support Group. The two-hour sessions are for both the person diagnosed with Alzheimer’s Disease, or a related dementia, and their caregivers. Alzheimer’s Arkansas co-sponsors the group with the Reynolds Senior Health Center. Contact Priscilla Pittman at Alzheimer’s Arkansas at (501) 224-0021 or toll free at (800) 689-6090 for more information.

HEALTHCARE HIGHLIGHT
Reducing the Risk of Alzheimer’s Disease

Alzheimer’s disease can affect almost every aspect of a person’s life, including that person’s memory, ability to think and communicate, and even his or her personality. Researchers like Cornelia Beck, Ph.D., RN, FAAN, are working steadily to learn the cause of this devastating disease.

Dr. Beck, Director of the Alzheimer’s Disease Center at the University of Arkansas for Medical Sciences (UAMS), is a Professor in the Department of Geriatrics and an Adjunct Professor in the Department of Psychiatry and Behavioral Sciences and in the College of Nursing at UAMS. She said that although the exact cause of Alzheimer’s is not known, scientists suspect a complex set of factors.

“Studies have shown that the greatest risk factor for developing Alzheimer’s is increasing age,” Dr. Beck said. “While as many as 10 percent of all people 65 years of age and older have Alzheimer’s, half the people 85 and older have the disease.”

Other risk factors include a family history of the disease, severe or repeated head injury, and disorders such as high cholesterol and high blood pressure – the same factors that cause strokes and heart disease.

Familial, or inherited, Alzheimer’s accounts for less than 10 percent of cases. This form of the disease starts before age 60, sometimes as early as age 30, and progresses quickly. The more common sporadic form of Alzheimer’s accounts for 90 percent of cases and typically begins after age 65. Although it has no definite hereditary pattern, half of all patients with this form of Alzheimer’s have a gene called ApoE4, found on chromosome 19.

“Alzheimer’s resembles other chronic diseases in that interconnected factors, including those associated with lifestyle, are involved in disease development,” Dr. Beck said.
New research has shown that people who have obtained higher education and participate in regular physical activity have a significantly lower risk for developing Alzheimer’s. Scientists believe that an active mind and body, which help to maintain strong connections in the brain, can delay or prevent the degenerative process that leads to Alzheimer’s disease.

Following a healthy diet that is low in cholesterol and fat also is believed to reduce a person’s risk for Alzheimer’s disease. Vitamin E and folic acid may also play an important role in Alzheimer’s prevention. Vitamin E is found in vegetable oils, nuts, meat, green leafy vegetables, cereals, wheat germ, and egg yolks, or in supplements. Foods rich in folic acid include green leafy vegetables, citrus fruits and juices, whole wheat bread, and dry beans. It also is available in supplements.

While there are no medicines that prevent or cure Alzheimer’s, three drugs have been proven to slow its effects for up to two years (see “Putting the Brakes on Alzheimer’s,” page 7). The drugs are: Aricept (donepezil hydrochloride), made by Elsai America Inc; Exelon (rivastigmine), made by Novartis Pharmaceuticals; and Reminyl (galantamine hydrobromide), made by Janssen Pharmaceutica. Nearly 50 more medications are in development.

So, while there is currently no cure for Alzheimer’s disease, Dr. Beck emphasizes that there are several ways to help prevent it. Keeping your mind and body healthy and active is perhaps the most important thing you can do for yourself … to reduce your risk for Alzheimer’s, and many other health problems, as well.

To learn more about the UAMS ADC, visit the Website at http://alzheimer.uams.edu, or contact Kathy Tyler King, RN, ADC Clinical Coordinator, at (501) 526-6500 or TylerKingKathrynA@uams.edu

Brain Studies Increase Understanding of Alzheimer’s Disease

At the beginning of the 20th Century, the world population was just 1.6 billion; electricity was showcased at the Paris World’s Fair; China was becoming a republic; and a German physician discovered a progressive form of dementia that now bears his name. Alzheimer’s Disease was discovered when Dr. Alois Alzheimer examined the autopsied brain from one of his patients and found an alarming degeneration of brain cells. Nearly 100 years later, most of our understanding of this disease still comes from the examination of autopsied brain tissue.

“Autopsy” is derived from Greek, and means “seeing with one’s own eyes.” To fully understand the cause of the disease, its destruction of the brain, and the resulting death of the patient, research scientists must “see with their own eyes” the course this memory-robbing disease has taken in the brain. Autopsy is an important tool and will continue to play a major role in most effective healthcare advances.

Today, the world population is exploding at more than 6.3 trillion; electricity is practically taken for granted; China is known as the People’s Republic of China; and Alzheimer’s disease affects up to four million people in the United States alone.

The UAMS Alzheimer’s Disease Center at the Reynolds Center on Aging encourages autopsy as a way to better understand, and hopefully conquer, this disease. For information about donating your brain for Alzheimer’s disease research, please contact Dr. Robert Mrak at (501) 686-7568.

Symptoms of Alzheimer’s Disease

People with Alzheimer’s disease may have trouble remembering, communicating, learning, thinking, and reasoning. These problems can become severe enough to affect their work, social activities, and family life. The Alzheimer’s Association has developed the following checklist of common symptoms.

1. Memory loss. Alzheimer’s patients often forget things and do not remember them later.
2. Difficulty performing familiar tasks. Alzheimer’s patients may not know how to prepare a meal, use an appliance, or participate in a lifelong hobby.
3. Problems with language. Alzheimer’s patients often forget simple words or substitute unusual words, which makes their speech or writing hard to understand.
4. Disorientation. Alzheimer’s patients can easily become lost, and forget where they are and how they got there.
5. Poor or decreased judgment. Alzheimer’s patients may dress without regard to the weather and show poor judgment about money.
6. Problems with abstract thinking. Alzheimer’s patients can forget what numbers mean, how to add and subtract, and other abstract concepts.
7. Misplacing things. Alzheimer’s patients may put things in unusual places, such as putting an iron in the freezer.
8. Changes in mood or behavior. Alzheimer’s patients can show rapid mood swings for no apparent reason.
9. Changes in personality. Alzheimer’s patients can become extremely confused, suspicious, fearful, or dependent on a family member.
10. Loss of initiative. Alzheimer’s patients may become very passive, sleep more than usual, or not want to do routine activities.

Putting the Brakes on Alzheimer’s

Alzheimer’s disease is a cruel progression of symptoms that rob a person of memory, independence, and finally life. While there is no cure for the disease, medications are available that can significantly reduce its effects.

Three FDA-approved drugs are currently on the market – Aricept®, Excelon®, and Reminyl®. These drugs, known as cholinesterase inhibitors, are used to treat patients with mild to moderate Alzheimer’s disease by increasing the level of acetylcholine in the brain. This chemical is responsible for memory and function and is reduced in the brains of people with Alzheimer’s disease. Studies indicate that those who take one of these drugs often show improvement in memory and comprehension, and may experience a delay in the progression of the disease.

Melanie B. Pilcher, Pharm.D., a Clinical Pharmacist in the Donald W. Reynolds Department of Geriatrics, emphasizes that these medications do not cure Alzheimer’s disease. “They will help to maintain patients at their current level and prevent a rapid decline,” Pilcher explained. “The decline is still going to occur, but more gradually.”

A study conducted using Aricept showed that Alzheimer’s patients in the early stages of the disease who regularly took the prescribed dose were able to live at home, instead of at a long-term care facility, for up to two years longer than those who did not take the medication.

Aricept, Execelon, and Reminyl may have side effects, including nausea, vomiting, abdominal pain, and weight loss. Other side effects may include unusual dreams and leg cramping. However, many patients find that these problems subside after using the medication for two or three weeks. If a patient has difficulties with one medication, switching to another of the three might be an option.

A fourth medication, Memantine, is currently being reviewed by the FDA. If approved, this drug may be used in conjunction with cholinesterase therapy to treat patients with moderate to severe Alzheimer’s disease. The drug has been used in Germany for over ten years to treat various symptoms of dementia.

For more information about drugs used to treat Alzheimer’s disease, ask your family physician, or contact the Donald W. Reynolds Center on Aging at (501) 296-1000. To learn more about Alzheimer’s disease, see the “Healthcare Highlight”.

Palliative Care Service Provides End-of-Life Care

Medical research has found ways to slow the progress of many diseases which used to bring about a rapid death. Such advances may allow patients several more years to enjoy life, but they can also mean patients must endure chronic symptoms as the still incurable disease continues to advance. Palliative treatment uses medicine to manage the symptoms of such illnesses, and palliative physicians work closely with patients and their families to make sure they understand the illness and what to expect as it progresses.

For many people, “palliative care” is a foreign term. And when used with the term “hospice,” it can take on a hopeless connotation. But palliative care actually describes a service that offers emotional support and freedom from pain.

The Palliative Care Service (PCS), directed by Reed Thompson, M.D., is an integral part of the Donald W. Reynolds Department of Geriatrics. The PCS provides care for patients who have far-advanced illnesses for which no curative therapy is being offered. Ambulatory patients are seen in the hospital and in the outpatient clinics at the University of Arkansas for Medical Sciences (UAMS) and the Little Rock VA Medical Center. Outpatient clinical services are provided three half-days per week at UAMS and two half-days per week at the VA Medical Center. Hospital consults are answered five days per week at both hospitals, as they are received.

When clinic patients are no longer ambulatory, they are referred to community hospice organizations. PCS physicians act as the primary care physicians for most PCS patients referred to hospices, which means that these physicians continue to be responsible for the patients’ end-of-life care. Nonambulatory patients who live in the Little Rock area are visited by PCS physicians at home on a limited basis.

To schedule an appointment, call the surgery oncology office at (501) 686-8211 for the UAMS program or (501) 257-4540 for the VA program.

Copyright © 2005 Donald W. Reynolds Institute on Aging University of Arkansas for Medical Sciences 4301 W. Markham Slot 748 Little Rock, AR 72205 (501) 296-1000 (800) 942-8267 geriatrics@uams.edu Notice of Privacy Practices