elderly care

Improving elder care through physician-pharmacist teamwork

A new study from UK researchers shows that when physicians and pharmacists work together more closely, care for elderly patients can be improved.

The findings, published in Alzheimer’s Research and Therapy, show the value of physician-pharmacist teams in providing more coordinated care for elderly patients, especially as it relates to prescription medications.

As people age, the number of medications they’re prescribed tends to increase, which makes both patient care and medication therapy more complicated. In the U.S., patients over 60 take an average of five medications, many of which are prescribed by different physicians. This increases the risk of inappropriate drug prescriptions and side effects, including cognitive impairment.

Ensuring medications are prescribed appropriately is especially important for patients living with Alzheimer’s disease and other dementias. Anticholinergic drugs – used to treat nausea, peptic ulcers, lung disease, dizziness and other conditions common in elderly patients – are often the culprits of inappropriate prescriptions.

Although they sometimes prove helpful, these medications have also been known to result in cognitive decline. Therefore, it is essential to find the right balance between risks and benefits for each individual patient.

Creating a medication therapy management team

In order to examine this further, Dr. Daniela Moga from the UK College of Pharmacy and Dr. Greg Jicha from the UK Sanders-Brown Center on Aging partnered to conduct an eight-week randomized trial with patients from Sanders-Brown.

Their aim was to investigate whether a targeted patient-centered, pharmacist-physician medication therapy management team intervention could reduce the inappropriate prescribing of anticholinergics. The research was the first step in evaluating whether intervention can improve cognitive function in patients.

Their findings showed promise. Compared to the control group, patients receiving the intervention showed a reduction in the number of prescribed anticholinergic drugs. In addition, patients appreciated the opportunity to participate in the study and recognized the importance of optimizing their medical treatment.

Expanding the research

Now with funding from the National Institutes of Health, Moga and Jicha will follow a larger group of patients for one year, and further evaluate the long-term effects of intervention by a medication therapy management team.

Physicians are constantly managing risks and benefits of medications with patients, and sometimes the potential for adverse effects is not fully recognized.

“When physicians and pharmacists work together, everyone wins,” Moga said. “It’s clear that including a pharmacist on the patient-care team means better outcomes and better healthcare for patients.”

“This study highlights the benefits of patient-centered medical teams that improve drug choices and the health of elderly patients, many of whom have highly complex medical conditions and needs,” said Greg Graf, assistant dean for translational research and UK College of Pharmacy faculty member. “The project is a collaborative effort between the UK Colleges of Medicine and Pharmacy, and we’re proud of the work we’re able to do together.”

This research was funded in part by the UK Center for Clinical and Translational Sciences, Sanders-Brown Center on Aging, the National Institutes of Health, the Office of Women’s Health Research and the National Institute on Drug Abuse.


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Dr. Matthew Gentry

Video: UK scientist explains his unique path to studying disease

When UK researcher Matthew Gentry began his career studying the biology of plants, he didn’t realize he’d someday be pursuing a cure for a human disease.

“You have to be willing to go where the science takes you,” says Gentry, a professor in the UK College of Medicine.

In Gentry’s case, the journey began when he found that a certain plant protein behaved similarly to the human protein that plays a role in Lafora disease – a rare congenital neurodegenerative condition that causes severe epilepsy, loss of speech and muscle control, and dementia, eventually leading to death.

This discovery provided information that medical researchers around the world are using today to test potential therapies for this deadly disease.

The research was also a step toward the development of methods to modify starch, with applications in the manufacturing of products such as plastics, animal feed, glue and clothing.

On a molecular level, the overlap between plant and human biology is tremendous, Gentry explains.

“Not long ago, the prevailing thought was that you could either work to cure a disease or you could work to figure out how something [a plant, a cell] functions,” Gentry says. “We are now at the point where the two intersect.”

Gentry spends much of his time advocating for more science funding through his work with the American Society for Biochemistry and Molecular Biology. The current funding landscape is such that scientists must spend more and more of their time writing grants, which takes them away from doing meaningful research, he explains.

He also hopes that more of this funding will support the types of basic research that shed light on cellular function and dysfunction.

“This type of research can have implications for many diseases, not just one,” he says. “We need to be careful not to silo all the research dollars for specific diseases because that sometimes doesn’t allow the best science to get done.”

Watch the video below to learn more about Dr. Gentry’s innovative research.


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exercise memory

Could exercise help ward off dementia? UK study aims to find out.

Allison Caban-Holt

Allison Caban-Holt

Written by Allison Caban-Holt, PhD, of the UK Sanders-Brown Center on Aging

Experts at the World Health Organization say that a sedentary lifestyle is one of the leading risk factors for death worldwide. We all know that being active can reduce our risk for diabetes, heart disease or even stress. But might it also help ward off dementia?

Recently, researchers have been studying the relationship between exercise and cognitive performance, bringing hopeful news about the benefits that exercise can provide patients who have degenerative brain diseases and cognitive impairment caused by Alzheimer’s disease.

The UK Sanders-Brown Center on Aging is one of 15 centers pairing with YMCAs across the country for a study called “Exercise in Adults with Mild Memory Problems,” or EXERT. EXERT will explore whether physical exercises such as stretching, balance and range of motion versus moderate-to-high intensity aerobic exercise can slow the progression of early Alzheimer’s disease memory problems (known as “mild cognitive impairment”) in older adults.

Participants will receive a free 18-month membership to a participating YMCA, a free personal trainer for 12 months, a personalized exercise program, medical evaluations and the opportunity to relax, meet new people and have fun.

To be part of this trial, participants must be between 65 and 89 years of age, experiencing mild memory problems, and able to exercise four times a week at the Lexington High Street YMCA for 18 months. Other criteria for the study include general good health, no recent history of regular exercise and not currently on insulin.

For more information about participating, please contact Molly Harper, EXERT study coordinator, at molly.harper@uky.edu or 859-323-2978, or visit the National Institutes of Aging website.

You or someone you know might be able to help prove the idea that “what’s good for the heart is good for the brain.”


Next steps:

  • Sanders-Brown recently teamed up with The Balm in Gilead to raise awareness about memory-related disorders in the African-American community. Learn more about the partnership.
  • Alzheimer’s disease usually affects people who are 65 or older. If there’s a senior in your life, be aware of these signs and symptoms of the disease.

UK partners with faith organization to address memory loss in African-American communities

Phyllis Wilson knows all too well the devastating impact Alzheimer’s disease can have on an individual and the family.

Growing up, Wilson watched Alzheimer’s disease take her mother’s life. Her painful memories of watching her suffer from the symptoms of the disease remain with her to this day. When she first started noticing signs of the disease in herself, she enrolled in a clinical trial at the UK Sanders-Brown Center on Aging, not just for herself, but for her children and grandchildren.

“I worry about what that did to my family. It’s hard to watch; I can’t describe it. I know I don’t want to be in that predicament,” Wilson said. “I read about a clinical trial at the Sanders-Brown Center at UK and I wanted to get involved. It won’t help me, but it might help my kids and grandkids.”

Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out simple tasks. More than 5 million people in the U.S. are currently living with the disease, and that number could rise as high as 16 million by 2050.

African-Americans like Wilson are two times more likely to develop Alzheimer’s disease than Caucasians and are less likely to have an early diagnosis of their condition, which means less time for treatment and planning.

In an effort to the limit the toll Alzheimer’s takes in the African-American community, Sanders-Brown recently teamed up with The Balm in Gilead to raise awareness about memory-related disorders. The Balm in Gilead is a faith-based organization that addresses prevalent public health issues among African-Americans.

As an aspect of the partnership, Sanders-Brown developed educational materials to be distributed in churches and other faith-based organizations during The Balm in Gilead’s Memory Weekend event. Memory Weekend launched in Lexington on June 11 and was celebrated in 25 churches across Kentucky.

Awareness can lead to early diagnosis

There are no known genetic factors to explain why African-Americans are at an increased risk for Alzheimer’s. However, the known risk factors for the disease, such as high blood pressure and diabetes, are more common in African-Americans.

The Alzheimer’s Association reports that African-Americans are less likely than Caucasians to have a formal diagnosis of their condition because they are less likely to report symptoms of memory loss to their doctors. That’s why spreading awareness about Alzheimer’s disease among African-Americans in non-medical settings is crucial to early diagnosis.

Markeda Yarbrough, a clinical research assistant at Sanders-Brown, says the church is the single most important influence in bringing the African-American community together.

“It’s about building trust in a community where there is a great deal of mistrust of the medical community,” Yarbrough said. “Church members will often go to other church members with health concerns. It’s a place where members can go to other members who are knowledgeable and caring.”

Yarbrough said that African-American women tend to be screened for Alzheimer’s four to five times more than African-American men, who are more reluctant. If not diagnosed in the early stages, the disease may progress so far that treatments aren’t as effective.

Wilson says although she’s not comfortable approaching people to initiate a conversation about Alzheimer’s disease, she has no problem talking about it if someone were to ask her.

“I don’t want other people to have to deal with this disease,” she said. “When I think about what it did to my family, it kills my soul.”


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Kentucky Neuroscience Institute recognized for high-quality stroke patient care

The American Heart Association and American Stroke Association recently honored UK HealthCare’s Kentucky Neuroscience Institute (KNI) with the Get With The Guidelines-Stroke Gold Plus Quality Achievement Award and the Target Stroke Honor Roll Elite Plus Award.

These achievements recognize UK HealthCare’s commitment and success in adhering to the most current, evidence-based stroke treatment guidelines for stroke patient care and outcomes.

To receive the Gold Plus Quality Achievement Award, hospitals must achieve 85 percent or higher adherence to all Get With The Guidelines-Stroke achievement indicators for two or more consecutive 12-month periods. They must also achieve 75 percent or higher compliance with five of eight Get With The Guidelines-Stroke quality measures.

The Target Stroke Honor Roll Elite Plus recognition is given to hospitals that treat more than 75 percent of appropriate patients with clot-busting drugs within 60 minutes of arrival and more than 50 percent within 45 minutes.

The quality measures are designed to help hospital teams provide the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. They focus on appropriate use of guideline-based care for stroke patients, including aggressive use of medications such as clot-busting and anticlotting drugs, blood thinners and cholesterol-reducing drugs, preventive action for deep vein thrombosis, and smoking-cessation counseling.

Larry Goldstein, MD

Larry Goldstein, MD

“Comprehensive Stroke Center status reflects our capability to provide the most advanced care for patients with stroke,” said KNI Co-Director Dr. Larry Goldstein. “These awards further underscore the hard work of our multidisciplinary team of neurologists, neurosurgeons, emergency physicians, nurses, therapists and others to optimize care delivery for stroke patients right here in Lexington.”

2017 marks the seventh year that KNI has received Gold Plus designation. It is the only hospital in Lexington to have both the Get With The Guidelines Stroke Gold Plus and Target Stroke Honor Roll Elite Plus designations.

The KNI Stroke Center is also certified as a Comprehensive Stroke Center by The Joint Commission – its highest honor.


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stroke

6 ways to prevent a stroke

When it comes to preventing a stroke, simple lifestyle changes can make all the difference.

Strokes occur when blood vessels that carry oxygen and nutrients to the brain burst or are blocked by a clot. When that happens, brain cells begin to die, affecting a person’s memory and ability to control muscles.

Stroke is the fifth-leading cause of death in the U.S. and in Kentucky, but there’s good news: Nearly 80 percent of all strokes are preventable.

In celebration of American Stroke Month, we’ve put together a list of things you can do to live a healthier lifestyle and better your chances of avoiding a stroke.

1. Get moving.

Regular physical activity will help lower your cholesterol and blood pressure, two of the biggest risk factors for stroke. Aim for 30 minutes of moderate activity five times a week. Something as simple as a brisk walk or bike ride with a friend will work wonders for your overall health.

2. Stop smoking.

Smokers are twice as likely to experience a stroke as nonsmokers. That’s because smoking thickens blood and increases the likelihood of clots. If you’re struggling to quit smoking, ask your doctor for help. And check out our blog with tips and resources that can help you or someone you know start on the path toward success.

3. Eat your vegetables.

And beans, whole grains and nuts, too – all of which are staples of a healthy diet. Improving your diet will help lower your cholesterol and blood pressure and help you maintain a healthy weight. Check out our guide for kick-starting a healthy diet.

4. Drink less.

Alcohol can increase blood pressure and the risk of stroke. Moderation is the key: For men, no more than two drinks a day, and for women, no more than one.

5. Learn about Afib.

Atrial fibrillation, also known as Afib, is a type of irregular heartbeat. If left untreated, Afib can cause blood clots in the heart that can move to the brain and cause a stroke. Talk to your doctor about Afib if you experience symptoms such as heart palpitations or shortness of breath. Learn more about the UK Gill Heart & Vascular Institute’s Heart Rhythm Program and listen to a podcast with our Afib specialist, Dr. Ted Wright.

6. Understand the things you can’t control.

Although improving your diet, ramping up your activity and living a healthy lifestyle can all decrease your risk for stroke, there are some risk factors you cannot control. Things like age, gender and race all play a role in stroke risk, and even though you can’t change those factors, it’s important to understand if you’re more susceptible.

Click the icon below to see our Stroke Quick Facts inforgraphic.

Stroke quick facts infographic from UK HealthCare


Next steps:

  • At the UK Comprehensive Stroke Center, we offer treatment, prevention and rehabilitation services for stroke patients. Learn more about our program.
  • Dr. Gretchen Wells, director of UK’s Women’s Heart Health Program, writes about why knowing your family health history can help you understand your own risk of disease. Read her blog.

 

Bruce Smith

Facing permanent brain damage, patient turns to UK for unlikely answer: a liver transplant

In 2011, Bruce Smith sat in his office preparing to make handouts for a meeting, like any other normal work day. But when he sat in front of his computer, he suddenly realized something frightening: He’d lost all understanding of how to use the machine. Bewildered at the sudden lapse in cognition, he said his coworkers thought he was joking around.

“I finally said, ‘I’m serious!'” Smith said. “‘There’s something going on here.'”

That moment was the first of many “lapses” to come. Smith was a diabetic, and his doctors initially thought his mental fog episodes were due to low blood sugar. When that was ruled out, they suspected he might be suffering from a series of mini-strokes.

“It was like I was taking a trip but never leaving the farm, you know?” said Smith, who is from Belfry, Ky. “I was awake but always taking naps.”

It wasn’t until Smith was referred to UK HealthCare that he got a diagnosis: hepatic encephalopathy, a term used to describe the mental fog that accompanies severe liver failure and a common occurrence in patients in need of a transplant. The liver’s job is to filter toxins from the body, and when it fails, the toxins accumulate in the bloodstream and wreak havoc elsewhere.

The team at UK determined that Smith’s liver was failing due to non-alcoholic cirrhosis. Although neither of his parents had the disease, one may have been a carrier and passed the gene down to Smith.

After getting a second opinion from the Cleveland Clinic confirming the diagnosis, Smith opted to remain at UK to be listed for a transplant. Liver transplant patients are assessed with a score known as the Model for End-stage Liver Disease, or MELD, which measures the amount of toxins in the blood and determines the patient’s position on the transplant waiting list. The higher the MELD score, the greater the severity of the disease and need for transplant.

Making the case for a transplant

Smith’s MELD score remained relatively stable for the next four years. However, his mental function continued to decline. As Smith’s symptoms worsened, his doctors at UK referred him to neurologists at the Kentucky Neuroscience Institute, where they diagnosed him with a much more serious condition.

“Bruce started out with hepatic encephalopathy, but then developed hepatocerebral degeneration, an extremely rare form of brain injury,” said Dr. Malay Shah, director of the liver transplant program at UK. “The exact cause of this disease is unknown, but liver transplant is the only cure.”

Many symptoms of hepatocerebral degeneration closely resemble those of Parkinson’s disease. In Smith’s case, he had trouble with speech, gait ataxia (uncoordinated movement and problems with balance) and ever-worsening dementia. Smith says he was essentially home-bound. He was unable to return to work, often couldn’t go to church and avoided going out for fear of experiencing an episode.

“I was asking, ‘Why me, Lord?'” he said. “‘What’s going on?'”

Although Smith’s liver toxicity remained stable – thus keeping his MELD score lower than necessary to receive a transplant – Shah said he knew he needed to push harder for Smith to be transplanted as soon as possible. He wrote a letter of appeal to the United Network for Organ Sharing (UNOS), a nonprofit organization that manages the nation’s organ transplant system, making the case for the severity of Smith’s situation.

“I appealed to UNOS to make Bruce’s MELD score higher than his lab values would suggest because hepatocerebral degeneration needs to be treated with a liver transplant,” Shah said. “Without an expeditious transplant, this disorder becomes permanent and irreversible. At that point, a transplant would be contraindicated because of the permanent neurologic damage from the disease.”

Shah’s appeal was successful, and on Sept. 27, 2015, Smith got a call from UK just as he was arriving home from church. He and his wife packed up and headed to Lexington to prep for surgery.

“I had all this happiness, excitement,” Smith said. “But also the fright of undergoing a major surgery.”

At 2 a.m. the next morning, Smith received his new liver – and a new lease on life. Since his transplant, things have improved drastically. He recovered fully from the surgery, and he underwent physical and occupational therapy to build back his strength and improve some of the basic skills he’d lost during his illness.

“I had to relearn how to write straight,” Smith said. “I had to use a ruler to sign paperwork.”

Becoming an organ donor advocate

As a surgeon who sees firsthand what a difference a transplant can make in the lives of his patients, Shah is passionate about raising awareness for organ donation. He notes that part of his job is making sure patients understand the gift they’ve been given.

“Our patients rely on the generosity of others to have a second chance in life,” Shah said. “And that’s exactly what I impart on my patients prior to transplant – that they and I literally owe it to the donor and their family to do the very best we can to take care of that generous gift.”

One way Smith is using his gift is by educating others on his personal experience. He is now a member and ambassador for Kentucky Organ Donor Affiliates (KODA), the organization that runs the Kentucky Organ Donor Registry, educates the public on organ donation and honors those who have given the gift of life. He was recently featured on a billboard for KODA in Eastern Kentucky and says sharing his story is one thing he can do to honor his donor.

“What a selfless decision that person, or their family, made,” Smith said. “This is my way of giving back. Hopefully, it will get folks interested in becoming a donor and ultimately making a difference in someone else’s life.”

“Bruce is a wonderful patient and a great donor advocate for KODA,” Shah said. “It’s nice to see folks like him work with the organ bank to help educate others in their respective communities about how organ donation can help their neighbors.”

Although he is unable to work, Smith has returned to an active lifestyle that includes walking, performing and creating. He plays guitar as a hobby and gives lessons to those in his community. He has a small workshop behind his house, where he dabbles in woodworking and metalworking. None of these things would have been possible without the transplant he received a little less than two years ago.

But perhaps most importantly, he says, he lived to be able to hold his first grandchild, born just over a month ago, with a second grandchild coming next month.

“You push through death’s doors and go through what I’ve been through,” Smith said, describing his thoughts when he first held his grandchild, “and I just thank God that I’m alive to hold this little thing.”

Smith holding his newborn granddaughter -- his first.

Smith holding his newborn granddaughter.


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UK student celebrates graduation one year after suffering strokes

Allison Couri graduated from UK May 5, but hers was more than the ordinary triumph over class loads and term papers. With the help of stroke experts at the Kentucky Neuroscience Institute, the Peoria, Ill.-native triumphed over health problems few 20-somethings face.

A little more than a year ago, Couri, then 21, came to the UK HealthCare Emergency Department complaining of headaches and dizziness. A CT scan identified that she had a stroke, and she was admitted to the hospital and assisted by the stroke care experts at the Kentucky Neuroscience Institute. Couri suffered more strokes, leaving her with a gait, slurred speech and blurry vision. She was diagnosed with lupus, which can lead to a rare complication called inflammatory vasculitis a condition marked by inflamed blood vessels that can also cause strokes.

After chemotherapy to treat her lupus, rehabilitation to address the effects of the strokes, and with the help of her service dog, Magnolia, Couri was able to finish her studies at UK and graduate. She plans to pursue a law degree.


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Sanders-Brown Center on Aging

Watch: 6 families coping with Alzheimer’s share their stories

Alzheimer’s doesn’t just affect the person with the disease; it affects their family and friends, too. A new video from the UK Sanders-Brown Center on Aging chronicles the emotional journey of the wives, sons, husbands and daughters whose loved ones have been diagnosed with Alzheimer’s.

Titled “Our Story,” the video debuted at the Sanders-Brown annual dinner celebration on April 13 and featured the stories of six families whose lives have been affected by Alzheimer’s disease. (Watch the video below!)

Our Story shows how Sanders-Brown helps patients and their family and friends cope with the financial, psychological and emotional impact of the disease – and how many of them are giving back by participating in research at Sanders-Brown.

“Kentucky is so fortunate to have [Sanders-Brown] right in its backyard,” said Jon Vaughn, chairman of the Sanders-Brown Center on Aging Foundation. “It seemed right to focus on the Sanders-Brown research, education and clinical programs, and its profound impact on the people who suffer in Kentucky and beyond.”

About 70,000 Kentuckians suffer from the disease, and someone new is diagnosed with Alzheimer’s every 66 seconds. Linda Van Eldik, PhD, director of the Sanders-Brown, reminded those in attendance that while there is currently no cure for Alzheimer’s disease, Sanders-Brown is a world leader in efforts to find ways to slow down the disease process or cure it altogether.

In the end, however, Sanders-Brown’s mission isn’t just about numbers, test tubes or microscopes.

“It’s about patients and their families,” she said.

Watch “Our Story” below.


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Dr. Craig van Horne, director of the Deep Brain Stimulator Center at the Kentucky Neuroscience Institute, spoke about his aspirations and hidden talents.

Watch: 5 questions with neurosurgeon Dr. Craig van Horne

Neurosurgeon Dr. Craig van Horne came to Kentucky from Boston to pursue an idea: Could peripheral nerve tissue implanted in the brain reduce the symptoms of Parkinson’s disease?

Van Horne is the director of the Deep Brain Stimulator Center at the Kentucky Neuroscience Institute. He focuses his research on cellular and surgical therapies for Parkinson’s disease.

Deep brain stimulation, or DBS, is a surgical procedure that uses electrodes to stimulate areas of the brain, effectively overriding the damaged nerve’s electrical impulses and reducing many of the symptoms related to Parkinson’s disease. Van Horne is testing an experimental procedure called DBS Plus, which uses a patient’s own peripheral nerve tissue to prompt nerve regeneration and slow the disease process.

Van Horne says the teamwork and support at UK HealthCare – plus a healthy dose of Kentucky hospitality – fostered the atmosphere he needed to bring DBS Plus to fruition. (And having a lucky cap doesn’t hurt.)

Watch this episode of “Five Questions” to learn more about Dr. van Horne’s aspirations and secret talents.


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