RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Late-Life Depression and Psychosocial Factors: Clinical Screening Tools and Social Services for Older Adults in Junction City, Oregon. Project Date: 10/12/2009 Depression in common among older adults in the United States. Contributing factors to depression include biological, psychosocial, and environmental elements. Bereavement, caregiver strain, social isolation, financial strain, and physical disability are among the many psychosocial factors that contribute to the development of depression. Depression among older patients is important not only because it compromises quality of life for patients and their families and undermines the ability to maintain health and independent living, but also because it is an independent risk factor for mortality. While the development of pharmacologic agents for the treatment of depression have made significant impact on quality of life for many individuals, the continued importance of screening for and addressing psychosocial issues cannot be overstated. The goal of this project was to screen older patients in the Junction City area for depression, explore the psychosocial context in which depression exists, and educate health care professionals on the community resources available to address issues such as financial strain and social isolation. The Patient Health Questionnaire 2 was used to screen for depression and a student-designed questionnaire was used to screen for social isolation, community involvement, and daily activities. These two questionnaires, combined with brief patient interviews, revealed some correlation between depression and social isolation. To address issues of late-life depression and the underutilization of social services in the Junction City area, a notebook was developed for use by health care professionals at the Junction City Medical Clinic that included 1) a series of clinical tools for screening for depression, dementia, and activities of daily living; 2) a series of journal articles on the role of psychosocial factors in depression; 3) a questionnaire for use in screening for social isolation and obstacles related to community involvement; 4) information related to enrollment in Medicare through the Senior Health Insurance Benefits Assistance program, the Oregon Prescription Drug Program, and social services available through the Senior & Disabled Services office in Junction City; and 5) an article on house calls. Advance Care Planning Project Date: 8/3/2009 Gold Beach has a large percentage of elderly population. The largest age group is 45-64 at 33.5%, above the 27.1% of the Oregon average. The group of 75-84 year-old is at 9.1%, double the Oregon average. Heart disease, cancer and chronic lower respiratory disease are listed as the top three causes of death in Gold Beach from 2001-2005. Advance care planning seems to be more pressing in a small town with a higher elderly population. POLST and Advance Directives are available to facilitate the discussion of advance care planning. After witnessing two patients pass away in the ER with a POLST and DNR during my first week, I want to explore how the hospital and the providers in a small town manage advance care planning. How is Curry General Hospital incorporating POLST and Advance Directives into the care of their patients? The project involves chart review of recently hospitalized patients in 2009 to obtain a baseline of the number of people with and without such forms. Interviews were then conducted with the nursing, medical, and administrative staff to understand how the hospital manages these difficult issues. Recommendations were made based on the chart reviews and discussion with the staff. Screening for Dementia in the Primary Care Setting: Experiences at the North Bend Medical Center, Coos Bay, OR Project Date: 6/29/2009 Background: Dementia has emerged as a large and growing health care problem but it is often not diagnosed until later in the disease progression. Early diagnosis has the potential to minimize the burden on patients, family and caregivers; however, no randomized trial has evaluated the efficacy of dementia screening in primary care. Introduction: The purpose of this project was to determine whether a brief screening for dementia in this particular type of primary care setting would identify patients with some memory or cognitive impairment that required further neurocognitive testing. Another purpose of this project was to identify barriers to screening for dementia in this setting. Methods: In order to accomplish these goals, all patients over 70 years old without particular memory concerns were screened for dementia during a two-week period at one Internal Medicine Clinic at North Bend Medical Center in Coos Bay, OR. Also, a survey of Family and Internal Medicine physicians at NBMC was conducted to identify their perceptions of undiagnosed dementia in the community and to determine what prevents them from routinely screening their patients. Results: 20% of the patients screened had an abnormal Mini-Cog screening and 30% had an abnormal MMSE screening. 83% of physicians felt that many of their patients might have undiagnosed dementia. 80% cited a lack of time as the principal factor preventing them from screening. Only 20% frequently used the Mini-Cog for screening. Discussion: The fact that these patients were discovered is information that can be used to explore the issue of whether or not screening asymptomatic elderly individuals in this setting would actually be beneficial in detecting previously undiagnosed dementia. Some of the barriers that physicians identified to screening could potentially be resolved. Utilization of the POLST Form in Long Term Care Facilities in John Day, Oregon Project Date: 6/29/2009 The POLST (Physician Orders for Life-Sustaining Treatment) has helped translate patient wishes into tangible and specific Physician’s orders and helps to ensure that patient wishes during the dying process will be honored across various care settings. The use of the POLST form has increased dramatically since it was first developed at OHSU in 1991. Data from study done in 2004 showed that approximately 96% of Nursing Homes in Oregon used the POLST for around 50% of their residents. Furthermore, another study in Oregon indicated that rural areas are more reluctant to use the POLST forms and usage was less in these areas. My goal was to study the utilization of the POLST form in all of the long term care facilities in and around John Day, Oregon. I reviewed charts at Blue Mountain Nursing Home, Valley View Assisted Living, Country Spice Residential Care Facility and Blue Mountain Hospice. I also interviewed the directors of Elderberry House and Golden Heritage which are both adult foster care homes in John Day. I found that 100% of residents at these facilities have a POLST form in their charts and staff are well aware of the POLST and the patient’s wishes. Directors and staff at these facilities were also educated regarding the POLST Registry which is a way for emergency personnel to access the POLST when the actual form is not available. Further exploration needs to be done to assess the utilization of the POLST form among dying patients at home who are not living in a long term care facility and who are not involved in Hospice. The Usage and Understanding of the POLST Form among Independently Living Senior Citizens in Veneta, Oregon Project Date: 6/29/2009 Oregon has been very successful in implementing portable orders for end-of-life care via the POLST, which is used in nursing homes, hospitals and hospice. For elderly people that aim to stay in their homes until their final days, their introduction to the POLST is usually from a primary care provider. This project was conducted in the Garcia Senior Center lunch program in Veneta, Oregon, where many of the participants live-independently. The aim was identify if the POLST was being used, identify barriers to its use and to create a presentation to break through some of the barriers. In a total of 6 hours spent at the Tony Garcia Center, data was collected that showed the POLST was not commonly used. Barriers included lack of exposure to the topic, confusing medical terminology and the lack of enthusiasm to talk about end-of-life care. Additionally, two presentations on the POLST were given to break through some of the barriers and forms were filled out on a one-on-one basis. The result was an increased awareness and interest in making choices regarding end-of-life care, and an increase in the number of participants that have POLST forms filled out. The Rural Elderly: A difficult to manage health care system? Project Date: 2/9/2009 •61 million people live in the rural U.S. and 15 % of them are 65 years of age or older. When it comes to healthcare, the shortages have even greater implications for these rural elderly. So, it is the goal of my project to examine how rural elderly manage their healthcare. By using the current literature and interviews of patients and doctors, I have set out to understand if the rural elderly in Hood River find it difficult to manage their healthcare and to provide suggestions for improvements that all healthcare providers can use. Insomnia in the Elderly of Stayton, Oregon: Development of a Patient Handout for Improving Sleep Quality Project Date: 10/13/2008 Insomnia, whether it be difficulty falling asleep, staying asleep or simply poor quality sleep, is a common problem, estimated to transiently affect up to one third of adults. During a five week rotation in a family practice clinic of Stayton, Oregon, insomnia was identified as a common complaint. Diagnosis was established on the basis of patient history and treatment with medications was initiated, but non-pharmacologic treatments of insomnia were not discussed. Acquisition of information pertaining to the issue included casual conversation with practitioners and a review of relevant medical literature, as well as easily accessible online resources of patient information. From these sources, a patient handout for improved quality sleep was developed. Further investigation into the relevance of sleep hygiene education and insomnia in the region was accomplished through interaction and discussion with residents of assisted living facilities in the Stayton/Sublimity area, including the Lakeside Assisted Living Community and McKillop Residence. Visiting these local facilities confirmed that insomnia and sleep disturbance is a common problem that affects this community, particularly in the elderly. The positive response to the handout supports its potential as an education tool to be used in the primary care setting in the future. Will Baker City Lose Its Only Nursing Facility? An analysis of the St. Elizabeth Care Center Project Date: 10/13/2008 The St. Elizabeth Care Center is the only Nursing Facility in Baker City, OR. The Care Center serves a population of approximately 16,000 residents in Baker County, a disproportionately large percentage of which are senior citizens. When it was discovered that the Care Center faced a fiscal crisis that threatened its closure, an investigation was made into the impact this closure would have on the community’s seniors. Consensus input from those involved in long-term care in Baker suggested that closure would constitute the loss of a critical resource. A further investigation was made into the causes of the Care Center’s financial instability and changes were suggested to prevent closure. Preventing Caregiver Burnout in Grants Pass, OR Project Date: 8/4/2008 At any given point, there are 34 million Americans who provide full or part-time care to aging family members or spouses1. Unfortunately, caregiver stress and burnout continues to be an under-recognized and under-addressed phenomenon, despite its association with increased morbidity and mortality in both caregiver and care-recipient. The goal of this project was to identify resources readily available and easily accessible to caregivers in Grants Pass, Oregon. The design included observation of physician interactions with caregivers and their dependents at WellSpring Family Practice and Three Rivers Community Hospital as well as exploration of local, state, and national support resources for caregivers. Finally, the end-product of this project was a pamphlet outlining essential steps for the caregiver and elucidating the most useful and comprehensive resources available. The pamphlet was made to be distributed in the physician’s office and various other health resource offices (e.g. CareSource, assisted-living homes). Before the Fall: Fall Assessment and Prevention in the Greater Reedsport Area Project Date: 6/30/2008 Injuries related to falls place a large toll on society. This project assessed the burden of falls in the Reedsport Oregon service area and developed interventions to reduce this medical burden, through means of prevention. The medical doctors appear to do an excellent job at discussing fall risk with their patients. Both the local clinic and hospital treat many fall related injuries each year. The local clinic could focus a month of time to further prevent falls in the community through education and community service. A fall prevention handout was created and an educational month was proposed. The Underutilization of Available Social and Healthcare Services by Seniors in Junction City, OR Project Date: 6/30/2008 As the population in the United States continues to age, well-developed and funded social and healthcare services aimed at improving quality of care and delivery of services for seniors are more important than ever. This study attempted to identify available social and healthcare resources in the Junction City service area as well as identify reasons for their underutilization. The design was to interview clinic practitioners, patients, senior center staff and patrons, and social workers in the community over a 5-week rotation in a primary care setting, as well as include conclusions from appropriate journal articles. Adequate social services resources and health care clinic practices were identified. They included a Lane County funded social worker/case manager assigned to Junction City as a liaison for seniors, a well-developed website directory dedicated to resources for Seniors and Disabled persons of Lane County, an active senior center with low cost daily activities. Healthcare related practices included a satellite community clinic, nursing home visits, and a generic drug sample machine. Many barriers to utilization of these serviced were elucidated. They included incomplete access to available resource information, which was primarily internet based, a lack of knowledge of available services by clinic physicians, difficulty with transportation, reluctance for help based on current seniors’ fierce independent nature, lack of anonymity in a small town, and stigma regarding mental illness. In conclusion, it was determined that a better flow of dialog and information was necessary between physicians, social workers, and community support centers (senior centers/churches) to enable seniors to find appropriate resources. However, it was also determined that full utilization will be difficult until attitudes towards community aid are altered and seniors, and their families, are more accepting of social services support. Feasibility Study of Vitamin K Supplementation to Treat Patients with Unstable Anticoagulation on Warfarin at the Scappose Family Practice Clinic Project Date: 4/28/2008 The management of warfarin therapy affects a large segment of the aging population and is expensive and time consuming for the patients and clinicians. For many of the patients at the Scappoose Family Practice Clinic, it was a financial hardship to take time off work, find transportation and pay a $20 co-pay each time they needed their Warfarin dose adjusted. This is in addition to the financial and medical devastation such as stroke or hemorrhage that could result from a patient being under or over anticoagulated. The purpose of this community project was to design a study to test the hypothesis that 150mcg of daily Vitamin K could stabilize patients on warfarin in an INR range of 2-3 and reduce the frequency of warfarin dosage adjustments. Phase I consisted of a literature search and then based on previous studies developing inclusion and exclusion criteria which would be used to identify a subset of patients at the Scappose Family Practice Clinic who would be eligible for this study. Once these patients were identified, a retrospective chart review was done collecting data on these patients for the period 11/1/07 - 5/1/08. Phase II will involve giving these patients 150mcg of daily vitamin K and collecting data for 6 months. We will then compare the two data sets. If the results indicate that 150mcg daily vitamin K improves anticoagulation control in patients with unstable INRs, this protocol can then be initiated to the benefit of the patients and the clinic. Screening for Depression in the Elderly in the Primary Care Setting: Piloting the Use of a Two-Item Questionnaire in Florence, OR Project Date: 4/28/2008 Depression is a major health issue among the elderly, with approximately 10% of adults aged 65 or older suffering from clinically significant depression. This problem is particularly relevant to Florence, OR, which has a large and growing retirement community. A major obstacle to addressing this issue in the primary care setting is that of efficiently screening for depression in a geriatric population with many co-morbidities that can confuse or overshadow mental health issues, and limited time to administer screening tests. Currently, elderly patients at the Florence family practice are only screened for depression at certain visits, such as annual diabetic exams. This project piloted the use of the two-item Patient Health Questionnaire 2 (PHQ-2) among all elderly patients visiting their family practice doctor in Florence, OR as a brief, efficient means of identifying depression in this population. The screening questions were verbally asked of patients age 65 or older, and the questionnaire results were analyzed to determine both total rate of positive screens and the number of these that were previously undiagnosed as depressed. The results of this pilot use indicate that incorporating the PHQ-2 into regular screening of elderly patients visiting the clinic could substantially improve detection of depression in this demographic. Resources Available for Patients with Dementia in Columbia County, Oregon Project Date: 3/17/2008 Dementia represents a major health issue for geriatric patients in the United States. This study serves primarily as a community profile and assessment of the resources available to patients with dementia, specifically Alzheimer's disease and their families in Columbia County, Oregon. The study evolved during preliminary conversations with the staff of the primary care internal medicine clinic in St. Helens, Oregon. They identified the availability of resources for dementia as a consistent challenge in offering guidance to their patients. A survey of local resources was conducted which included site visits to nursing homes and senior centers, contacts with social workers, and internet searches for resources. The local resources were compared with those described in the medical literature and the National Alzheimer's Association. Questions to evaluate the effectiveness of the local resources were prepared for patients with dementia and their caregivers. A simple handout was prepared to identify key resources in the community and at large. “WI I ” TA S T I C : T H E I N T ROD U C T ION OF A NOV E L V I D EO G A M E CON SOL E I N TO A N U R S I N G HOM E Project Date: 12/31/2007 For nursing homes, the maintenance of physical activity is often an important, if not primary goal of day to day activities. It is commonly believed that lack of physical exercise will lead to exacerbation of co-morbid conditions and general overall decline. In many commercial nursing homes, this is primarily accomplished through group exercise as well as formal physical and occupational therapy.; each of these approaches has their limitations. The purpose of this project was to provide a qualitative analysis of the introduction of a novel video game console concept developed by Nintendo called the “Wii.” This console is unique in that it is one of the first to be introduced into the mass market that implements the use of physical interactive technology into game play. This task was accomplished through two general introductory sessions and two case study sessions with nursing home patients. Qualitative observations and analysis are reported with recommendations for follow studies that could be performed using a quantitative approach. Fall Prevention Services For Geriatric Patients In St. Helens, OR Project Date: 10/15/2007 Geriatric morbidity and mortality increases after fall injuries.1 Many of these falls may be avoided with fall-prevention strategies that involve improving geriatric strength and mobility. The goal of this study was to identify local fall-prevention resources and services for geriatric patients--specifically, programs that could provide mobility-assistance-device (i.e. canes, walkers) training, home fall-prevention safety consultations and home mobility improvements/installations. Geriatrics patients from the St. Helens, OR community and their medical and social services providers were interviewed. Although rehabilitation services in St. Helens for geriatric patients who have already experienced a fall injury are easy to identify and access, services to prevent healthy, active seniors avoid falls are not. Cycling in Florence, Oregon Project Date: 8/6/2007 Cycling is an excellent form of exercise, with physical, mental and environmental benefits. Many of the most common causes of morbidity and mortality have improved outcomes in patients who exercise on a regular basis. Florence, Oregon is a small, coastal town with an older retirement population. Many people in Florence suffer from chronic diseases that could be improved with exercise. This study attempted to identify the current perceptions of, barriers to, and support for cycling among older adult chronic disease management patients in the family practice clinic in Florence. Additionally, an environmental survey of Florence’s cycling amenities was done, revealing a mostly flat, small town with low traffic streets and well maintained multi-use paths. There is also a full service cycling shop with an owner dedicated to promoting cycling in Florence. Most barriers to and negative perceptions of cycling identified in this project would be combated by cycling education and skills training in either group or one-on-one setting. This process was started with a resource book created for this project including safety information, local and online resources, local maps, a biking activity, and copies of several articles with evidence for the benefits of cycling in older adult populations. "Exercise by Prescription" Project Date: 3/19/2007 A routine of exercise and physical activity has been shown to decrease morbidity in patients suffering from things such as heart disease, cerebrovascular disease, hypertension and osteoporosis. Physical Inactivity however has been correlated with many external factors beyond the patients’ control. This study attempts to identify key barriers to physical activity in a rural population, specifically among the elderly. The design was the questioning of patients over 50 who came to Klamath Family Practice, and the Merle West Medical Center in Klamath Falls Oregon. Each patient who was being seen as a follow up for hypertension, Diabetes, or was having a complete physical exam was questioned on the primary reason that they did not perform a routine form of physical activity and or exercise. 2 different focus groups of 10 and 12 senior citizens at Klamath Senior Center & Center for Aging were also questioned about the same issue. This study found that the major barriers included weather in Klamath, safety and motivation along with other barriers. Whereas there was a great deal of emphasis on the importance of physical activity, the barriers to those activities were not being addressed by physicians and/or residents. In fact it was rare that a consultation was held at all to discuss physical activity for many patients who would obviously benefit. Therefore my intervention sought to decrease the burden of those same barriers in an effort to motivate the patients to seek out the recommended amount of physical activity set forth by “Healthy People 2010.” This included but was not limited to, making trail maps for walking and jogging, convincing local fitness centers and rentals shops to give discounts to patients mentioning “exercise by prescription” from their doctor. Such a sheet of information and incentives give the physicians in office, something to have in hand in order to have a worthwhile discussion about exercise with patients and to hopefully further impact preventive care in Klamath Falls. Urinary Incontinence: Dribbling into the Golden Years Project Date: 3/19/2007 Reedsport, OR is an old logging town with an aging population. Unfortunately, its community is suffering from illnesses that increase with growing old, including urinary incontinence. Urinary incontinence affects up to half of all women eclipsing hypertension, depression, and diabetes in prevalence (Sutherland, 2004). It is associated with troubling morbidity such as falls, urinary tract infections, skin breakdown, depression, and social isolation (Resnick, 2004). Many women believe that urinary incontinence is a normal part of aging. Although the medicines and conditions that predispose urinary incontinence increase with age, UI is neither inevitable nor untreatable. With treatment, up to 90 percent of those with UI can improve (Khan, 2004). In towns like Reedsport, patients routinely wait up to 4 months for an appointment with an urologist. Fortunately, an urologist is only needed for the most recalcitrant cases, and family practitioners have the tools to diagnosis and treat the majority of patients. With this project I described the Reedsport community and why it carries a large burden from this problem. I also interviewed patients to better understand the problem and its impact. Then, I performed a literature review to learn how to best identify and treat UI. Finally, I created tools for diagnosis and patient education. Death with Dignity - a rural community's perspective Project Date: 2/12/2007 Context: End of life care is a subject that has become more important over the last decade. “Death with dignity” is often a phrase that is used when discussing quality end of life care. However, this phrase is still not well defined. Furthermore, end of life care has been recognized as an ethical obligation of health care providers and caregivers, but this concept has not been examined from the perspectives of residents of rural communities. Objective: The objective of this project is to identify and describe elements of quality end of life care from the perspectives of residents living in the rural town of Scappoose, Oregon, as well as determining the level of awareness of advanced directives and POLST forms amongst those residents. Methods: This study is a qualitative study conducted using face-to-face interviews with open-ended questions. A total of 45 participants from 2 patient groups: clinic patients (n=28) and residents of a long-term care facility (n=17). Results: The participants identified eight domains of quality end of life care: avoiding inappropriate prolongation of dying, receiving adequate pain and symptom management, achieving a sense of control, having a peaceful and comfortable death, relieving burden, knowing that they are going to heaven, and not being alone. Overall, less than 50% of the participants in this project were aware of POLST forms. Conclusion: The conclusions drawn from this project are that the domains identified, which characterize a rural community’s perspective on end of life care, can serve as points for improving quality end of life care. Some of the values held by residents of Scappoose may also give insight as to how those residents have defined “death with dignity.” This project has also revealed the lack of awareness of POLST forms amongst the rural community of Scappoose, expressing a need for increased education regarding POLST forms and end of life care. Depression in the Elderly - Community Resources in Reedsport, Oregon Project Date: 2/12/2007 Depression is a common problem in the elderly population. Literature shows that exercise and social interaction have a tendency to improve and maintain good mood. The goals of this project are to first explore the resources in the community for the senior population, then to evaluate the utilization of these services by conducting a survey, and lastly to develop a patient handout to increase awareness of local resources and to encourage physicians to incorporate exercise and social interaction into treatment plans for elderly with dysthymic mood. Many activities and programs through the senior centers and the senior & disability services are available locally. However, only 50% of those with dysthymic mood use the senior center, while 78% of those with good mood utilize the services. In addition, those with lower mood score are less likely to have a regular exercise schedule. In a rural setting where social workers are not readily accessible, it is beneficial for physicians to know the local resources in order to effectively help their patients. Meet Me In The Woodshed A Tragedy in a Small Town: Recognizing and Preventing Suicide in the Elderly Project Date: 1/1/2007 Elder suicide is major issue in Oregon and the United States. Suicide rates among persons age 65 years and older are the highest compared to any other age groups. In 2003 in Oregon, the suicide rate per 100,000 in people aged 65 years or more was more than twice the rate in people aged 15 to 34 years old (27.14 versus 13.41). This project aimed to quantify the problem of elder suicide, identify risk factors both generally and specific to Oregon and Tillamook County, and propose prevention strategies for the community and physician. Data sources included research studies on elder suicide, census and CDC statistics, and interviews with community professionals involved with suicide prevention and treatment. Risk factors for elder suicide overall include chronic disease, social isolation, and the misconception that elder depression is a normal part of aging. Oregon has the 4th highest elder suicide rate in the county and some factors specific for the elder Oregon population include living in a rural setting, “rugged individualism”, and firearm ownership. Physicians can help prevent elder suicide by encouraging a warm and trusting relationship with patients so that they feel safe sharing depressive thoughts. Physicians have tremendous power of influence with their patients’ health care decisions and can strongly recommend counseling and treatment for patients at risk. In the upcoming year, the Oregon DHS plans several community meetings to develop prevention strategies specific to the local area. Finally, a refrigerator magnet with important contact numbers for outreach and counseling services was designed for elder patients to have at available at home. The hope is that in the future, elder patients considering suicide will contact his friend, doctor, or counselor to begin their path to recovery. Assessment of Resources Available for Persons with Dementia in Florence Project Date: 1/1/2007 The population of persons over 65 is rapidly growing in the United States and this is especially true in rural communities, such as Florence, where this population makes up close to 40% of the total population4. One family practice clinic in Florence had close to 45% of its patients over the age of 655. Naturally, this would increase the number of age-related diseases, such as dementia, seen in this clinic compared to an average practice. Therefore, it is important for physicians to have easily accessible resources for themselves as well as for their patients. A resource guide was produced to help health care providers in the clinic better serve their patients with dementia. Perspectives on end of life preparedness and POLST implementation by providers in Reedsport, Oregon. Project Date: 1/1/2007 End of life planning is an emotionally charged topic of discussion for medical personnel, patients, and families. Throughout the country, the use of heroic and expensive treatment for those with terminal conditions is the subject of debate by medical personnel as well as ethicists. End of life practices vary by hospital and certainly by demographics. This project seeks to explore the attitudes and practices of seven medical practitioners in a family health clinic in a coastal community in Oregon. The unique environment that is embodied in this town is similar to other small rural communities across the country. Reedsport has a critical access hospital that contains 22 acute care beds with accommodations for two ICU beds. It also has an extended care facility associated with the hospital. Its ER is staffed primarily by local family doctors. The family practice clinic serving this health district is located immediately adjacent to the hospital. This presents a unique opportunity to evaluate the practice and implementation of end of life measures in different medical settings by the same medical practitioners. Many if not all of the patients who are admitted to the local hospital by the ER physicians are also the patients of these same practitioners of community based medicine. Attitudes toward end of life issues were sampled by personal interview and completion of a small survey. Strategies are discussed for the increased implementation of POLST forms in the practices of these providers and in their community. Successful Aging: Does Reedsport have what it takes to help its citizens over 65 age successfully. Project Date: 9/11/2006 In 2004, there were 36.3 million Americans over 65 years old; by 2030 this number will reach 71.5 million, a whopping 20% of the U.S. Population. In order for the aging population to age successfully - to have low incidence or risk or disease, to maintain mental and physical function and to actively engage in life - there must be certain community resources in place to help this happen. Reedsport is a community with many resources in the areas of community involvement, transportation and housing all of which influence how well people age. Reedsport offers those over 65 many opportunities to stay connected to the community, but the transportation and housing have room for improvement. Increasing awareness of opportunities for social interactions and physical activity for senior residents of Philomath, OR Project Date: 9/11/2006 Numerous studies have demonstrated the benefits of maintaining social interactions and engaging in physical activity for elderly people. These include an increased sense of independence, improvements in quality of life and general functioning, an increase in measures of mental health functioning, as well as lower rates of obesity, diabetes, osteoarthritis and cardiovascular disease. I sought to catalog resources in the community for opportunities for social interaction and physical activity and to overcome the barriers of cost and transportation to encourage utilization of these resources. I then designed a large color poster to encourage awareness of local opportunities, printed 30 smaller color handouts for seniors to take home, and compiled an informational binder to be housed in the waiting room at Philomath Family Medicine. Early Identification of Post-operative Needs of Hip Fracture Patients in Grants Pass, Oregon Project Date: 7/3/2006 Hip fractures are common and debilitating injuries that predominantly affect older people. They results in significant morbidity for those who suffer from them and place a considerable burden on the health care system. Three Rivers Community Hospital in Grants Pass, Oregon has initiated a comprehensive program directed at senior citizens in its service area that includes fall prevention, osteoporosis care and hip fracture treatment. An important part of treatment is meeting the post-operative needs of patients through timely and appropriate discharge planning. This student examined records of 91 patients treated at Three Rivers Hospital for hip fractures in 2005 to determine what factors at presentation predict length of hospital stay and whether patients are transferred to their homes or to skilled nursing facilities. Available charts were reviewed of the 93 hip fracture reductions performed at Three Rivers Hospital in 2005. Analyses demonstrated no relationship between the number of comorbidities listed for a patient and her length of stay in the hospital. 85% of patients required post-operative transfer to skilled nursing facilities. The mean age of those patients was 8 years older than the mean age of patients who were discharged to their homes. Also, patients bound for nursing facilities had an average of 2.2 greater comorbidities on admission than patiens who were sent home. Patients living at home with a spouse before injury were the most likely to be able to return home after surgery. Further investigation is needed to assess potential relationships between the types of fractures, types of procedures, and discharge plans. The ability to prepare for post-operative placement early in the course of treatment would facilitate the recovery process and provide for the optimally efficient utilization of hospital resources in Grants Pass. Medication Compliance in the Elderly Population of Grants Pass Project Date: 5/1/2006 Medication non-compliance is an important issue facing the elderly population because they have the highest prevalence of chronic disease and the largest consumption of medications. Non-compliance is associated with large increases in morbidity, mortality, hospital admissions, and cost to the community and health care system. This study was designed to evaluate and improve the factors contributing to medication non-compliance in the growing elderly population of an internal medicine clinic in Grants Pass, Oregon. Factors were identified using the following methods: extensive review of the literature on medication compliance, surveys of the patients regarding contributing factors, interview with the physician, and identification of resources currently available in the community. Based on the results, a patient handout with a medication log was constructed in order to address these problems and implemented in the internal medicine clinic. Both patients and physicians had a positive response to the handout, however there was not sufficient time to evaluate the effects of the handout/medication log on compliance. Additionally, further work beyond patient education is necessary in order to have the greatest impact on compliance including education of health care professionals and changes within the health care system. Assessment of Housing and In-Home Care Options for Seniors in Astoria Project Date: 5/1/2006 In Clatsop County, the percentage of the population over the age of 65 was 15% in 2005, but this number is projected to increase to 24% by the year 2025. The need for long term-care services is steadily increasing as well. Initiating the conversation about the need for more assistance in the home can be difficult for seniors and their families. Furthermore, once the decision has been made, determining the level of care needed and researching the options is complex. Within Pacific Family Medicine, it has been observed that seniors and their families are uninformed about the housing and in-home care options available in their community and lack adequate resources to make informed decisions about long-term care. The purpose of this project was to provide information about different types of housing and in-home care options for seniors, facilitate discussion between families about the need for more assistance in the home, and provide tools to help people assess their level of need and evaluate their options. The final product of this project is a resource guide to be utilized by seniors and their families. Charting Chronic Pain in Grant County Project Date: 5/1/2006 In the primary care practice of Dr. Robert Holland and Dr. Russell Nichols in John Day, Oregon, chronic pain visits occupy an average of 4-5 visits per day and these patients see the doctor 2-3 times more frequently than other chronic pain patients. The age distribution of Grant County is becoming top-heavy, with those >65 years old comprising 17.1% of the population, nearly five percent greater than the national average. Additionally, the number of manual laborers and individuals participating in outdoor activities that are tough on their bodies is commonplace in this population. Hence, the development of a standardized form for charting frequent pain management visits for musculoskeletal, neuropathic, fibromyalgia, longstanding post-surgical pain, and chronic narcotic use can save both time and money for a busy primary care practice. The average cost savings per physician in the practice from using a form rather than dictating progress notes from chronic pain visits is approximately $772 per year. Efficacy of this form is likely to be seen more in a rural setting due to the fact that there is little turnover of the population and few doctors, so there is greater longitudinal data collection. Optimal use of the form will allow for concise, long-term data collection and more focused pain management strategies that improve both the patient and physician satisfaction. Medication Compliance in a Small Subpopulation of Elderly Patients in the Illinois Valley Project Date: 5/1/2006 As patients age, their risk of developing chronic conditions such as hypertension, diabetes, and hyperlipidemia increases. These illnesses are manageable by taking medications, but eventually patients may find themselves taking multiple prescriptions which may actually make it difficult to treat their illnesses if they are unable to comply. One reason for this is that as people age they may have increasing difficulty remembering things and may not be able to keep track of many drugs. In a rural setting other factors such as low incomes and long distances may also play a part in medication noncompliance. The family practice clinic in Cave Junction, Oregon consists of almost 2,400 patients; 26% are over the age of 65 and several of them have multiple chronic conditions. The goal of this project was to determine whether there are barriers to compliance with taking medications in this rural community and to identify solutions to resolve them. Ten home visits and eight phone interviews were conducted to determine which systems patients use in remembering to take multiple drugs. Most patients had lists and/or pillboxes to help them remember and were taking everything as prescribed. It was therefore concluded that medication compliance in this small subpopulation of elderly patients is better than expected and that they are not currently plagued by barriers to compliance. Even though these patients are able to get their prescriptions filled now, however, they are worried about rising costs. Many of them are of low income and therefore struggle to pay for their medicines. Patients with Medicare Part D are particularly unhappy because they pay more now than they paid before it was implemented this year. Rising costs and the new prescription drug coverage plan may represent future barriers to compliance for these patients. Length of patient enrollment on Blue Mountain Hospice, The Physicians who refer patients and suggeted strategies to reduce late referrals Project Date: 3/20/2006 Blue Mountain Hospice (BMH) opened in August 2005. As with most hospices, one of its main concerns is that a significant proportion of its patients are enrolled for only a matter of a few days. The concern is that as a result, many of these patients and their families may not have time to fully benefit from the services hospice has to offer. The goals of this project were to 1) further the degree of mutual understanding between the physicians of Grant County referring patients to BMH and the staff of BMH; and, 2) provide recommendations and resources to both the physicians and BMH on possible strategies which may help to reduce late referrals. To accomplish these goals, the seven Grant County physicians were surveyed on hospice referral history, training and attitudes towards hospice, barriers to timely referral and interest in hospice related continuing education. Files of patients referred to BMH were then reviewed to characterize the population referred. Results indicated that referring physicians generally believe they are well trained in hospice, express positive attitudes towards hospice and are moderately interested in continuing education. Of the 15 patients enrolled with BMH to-date who ultimately either died on hospice (12) or were discharged (3), the median length of enrollment was 6.5 days and two patients were enrolled for only one day. Recognizing that certainly not all of the late referrals could have reasonably been avoided, recommendations and associated resources are provided to both BMH and the referring physicians with the intent that the proportion of late referrals can, over time, be reduced and more of the patients and their families can fully benefit from the unique services offered by hospice. Medicare drug plans in Burns, Oregon Project Date: 3/20/2006 In the town of Burns, Oregon, Medicare-eligible patients who had been receiving their medications for free from drug company patient assist programs (PAPs) were informed that most of the drug company assist programs would no longer provide their medications after the Medicare Part D deadline of May 15, 2006. In response to such news, there was much confusion for health care providers and patients. In addition to Medicare Part D, the federal government also instituted a separate subsidy program for the drug plan through Social Security to assist low-income patients. My project looked into all Medicare-eligible patients in the Burns health clinic who had received drug company assist in the past six months to see whether patients were deciding to join a drug plan and to gauge the extent of their knowledge of the additional help through Social Security as more patients on drug company assist would probably qualify for the extra subsidy than the general Medicare patient population. In Burns, there were a total of 163 patients who had received medications from drug company assist programs in the past six months, 116 (71%) of whom were Medicare-eligible. I conducted a phone survey to all the Medicare-eligible, PAPs patients and spoke to 71 patients (61%). Each patient was called at least twice over a course of three days. Maximizing Access to Prescription Medications in Ontario, Oregon Project Date: 3/20/2006 Medicare Part D is an insurance plan for prescription medications that recently became available to everyone enrolled in Medicare. It was designed to provide coverage for prescription medications regardless of income, health status, or costs. With over 450 different plans available in Oregon, and insurance coverage that varies depending upon prescription costs, many patients have questions about choosing a specific plan, and determining if Medicare Part D is right for them. The deadline for joining Medicare Part D without penalty is rapidly approaching, making it even more important for patients to be able to make informed decisions in a timely manner. This study looks at how residents in Ontario, Oregon are making important decisions regarding Medicare coverage, and identifies resources that patients have found useful. In addition, some of the complications with Medicare Part D have been identified, so that they may be avoided in the future. It is hoped that the results of this study will help patients make informed decisions about Medicare Part D, and maximize their access to prescription medications. Osteoporosis: Fractures in an Aging Population Project Date: 2/13/2006 Osteoporosis is a skeletal disease characterized by loss of bone mass and strength, leading to the increased likelihood of fragility fractures. Osteoporosis primarily affects the elderly and fractures due to osteoporosis are a principle cause of morbidity and mortality. The goal of this project is to increase awareness of patients and providers on prevention, screening, and treatment of osteoporosis. This was accomplished by examining the current practices of screening for osteoporosis by area providers and identifying the incidence of fragility fractures at Reedsport. A literature review was done to educate providers about the latest in bisphosphonate therapy, and finally a brochure was made to empower patients with knowledge about osteoporosis. From September 2004 to January 2006, there were a total of 53 total fractures in patients 60 years and older treated at Lower Umpqua Hospital. Forty six of the fractures were from low-intensity traumas and only 15% of these patients were previously diagnosed with osteoporosis or osteopenia. It appears osteoporosis is currently under-diagnosed in Reedsport. This is mainly due to provider’s views of the high cost of treatment for their patient’s and ineffective treatment options. Increasing vaccination rates in the elderly Project Date: 1/2/2006 Prevention of disease is one of the most important roles of the primary care physician. Vaccination is a simple and effective way to increase the health and decrease the healthcare spending in all communities across the nation. The elderly are particularly vulnerable to infectious disease and yet vaccination rates are low among the large elderly population of Josephine County. Over one in five people in Josephine County are over the age of 65. Nearly ten thousand over the age of 65 are 5 times increased risk of invasive pneumococcal disease due to inadequate pneumococcal vaccination. Over ten thousand elderly are at increased risk of hospitalization and death due to low influenza vaccination rates. The influenza vaccination itself is effective in decreasing hospitalization due to respiratory illness by 76% and death due to respiratory illness by 79%. In addition, each flu vaccine given saves an average of $47 in health care spending by those who receive it. This project’s ultimate goals are: to understand the vaccination rate and programs already in place within the county health department to increase vaccination rates in the elderly; to increase the vaccination rates in the elderly in Josephine County by supplying primary care physicians with a simple, concise information sheet for patients to help them understand the risks and benefits vaccination with the Influenza and Pneumococcal vaccines. This information was gathered from large cohort studies or RCT’s in the primary literature and these references were supplied along with the information sheet to primary care physicians in the area who wished to use them. Follow up research could be done in the peak influenza vaccination season to determine the effectiveness of the County Health Dept. planned interventions outlined in this project. Medicare Part D in Tillamook, Oregon and Its Implications: Both Financial and Ethical Project Date: 1/2/2006 January 2006 has ushered in a new era in American health care with the institution of the Medicare part D prescription drug benefit. Its promise is to improve prescription drug coverage for seniors. It has been championed as the financial savior for the elderly, but it may pose more problems than it could ever solve. There are actually many cases where the new program hurts the people it is meant to assist. This scenario became evident in a small town, Tillamook, Oregon, during my rural healthcare rotation. In talking with my prceptor, Dr. Parsons, it seemed there were many reasons why Medicare Part D may actually be doing our seniors a disservice. This new drug benefit may also carry with it some ethical issues as well, specifically, is this new program allowing physicians to do the most good for their patients? While Medicare Part D has the potential to ease the financial burden of healthcare for millions, it may pose hidden costs to both seniors and physicians. Medicare Part D Project Date: 1/2/2006 Medicare part D, is a new prescription drug plan being started by the government beginning this year January 1. There is lots of confusion regarding general information, how to sign up, and which plan to choose. This program affects a large amount of the community in Klamath Falls, since all people on Medicare currently are eligible. In addition there are many penalties and nuances of the program. The goal of the project was to find out more information on Medicare D and what it was about, to see the population’s grasp of the new program, and to see what was out there to help those who needed aid. A quick survey was distributed through the practice to see if people knew about Medicare part D. The only community resource in K. Falls was contacted, interviewed, and observed to see what educational opportunities were available to the public. Of the eligible parties only 55.8% were familiar with the new program showing a definite need to further educate those eligible. The effect of the new Medicare Prescription Drug Benefit on the 65 and older population at the OHSU Scappoose Primary Care Center Project Date: 9/12/2005 A significant number of the OHSU Scappoose Primary Care Center's patients who are 65 and older do not have prescription drug coverage. These patients bear the entire cost of their medications, and many carefully weigh treatment decisions based on cost. In the author's time at the Scappoose Clinic, numerous encounters were noted with patients from this population where prescription cost was a larger consideration in therapy selection than for those who have prescription coverage. This project describes how the clinic's patients will potentially be affected by new Medicare legislation, effective January 1, 2006, that will provide prescription drug coverage for millions of retired Americans. Increasing Access to Prescription Medications in the Elderly Population of Malheur County Project Date: 2/7/2005 Many elderly patients take prescription medications on a daily basis; however, the rising costs of these medications make it difficult for patients, especially those with fixed or low incomes, to afford them. For elderly patients in the rural setting, the problem of access to affordable medications is even greater because of the lack of social workers and other staff available to assist patients with applying for prescription assistance programs, Medicare discount cards, and other lower-cost prescription medication programs. Many patients report that their prescription drugs cause them financial hardship. This often leads to patients skipping or cutting down on doses or not filling the prescriptions at all. This is frustrating for both the patient and physician who both are trying to manage what are usually complicated medical conditions. Oftentimes, the physician, nurses, and other office staff take on the responsibility of helping patients access medication assistance programs, which is both time and resource consuming for the staff. This project looked at the elderly population represented in one family practice office in Ontario, Oregon, which is the largest city in Malheur County. A prescription drug questionnaire was utilized to query patients about out-of-pocket prescription medication costs, methods of cost savings (e.g. buying online, skipping doses, etc), and knowledge about cost saving prescription drug programs. A total of 22 patients, age 65 and over, completed the survey, with 45% responding that the cost of prescription medications cause them financial hardship. These patients spent an average of $187.00 a month on prescription medications, and 70% report having no prescription drug coverage. Of the 55% that did not experience financial hardship, 92% had some type of drug coverage and spent an average of $49 a month on medication. Of all the patients surveyed, 45% report using cost-saving methods, including using mail-order companies in Canada, price comparing among different pharmacies, using samples, skipping doses, and not filling prescriptions. Ultimately, the goal of this project was to identify ways to help patients gain access to affordable prescription medications in the most time and resource efficient manner. Development of a simple one page handout with prescription medication resources and consumer buying tips, which could be easily distributed to patients, was found to be the most efficient and helpful to patients. Successful aging in the elderly population of Scappoose, Oregon: A report on the resources and facilities available to encourage successful aging. Project Date: 10/18/2004 The elderly population is the fastest growing group of individuals in the United States. It has been shown that avoiding disease and disability, sustaining high functioning, maintaining and establishing social networks, and actively engaging in life all lead to successful aging in the elderly. Many elderly rely on community services to accomplish successful aging, and it has been shown that rural areas tend to have deceased availability of these services and professionals. This research project identifies and reports the resources available to the elderly population of rural Scappoose, OR in order to age successfully. Visits to the local nursing home, assisted living community, and senior citizens’ center were made. Interviews with staff were conducted and tools to promote successful aging in the elderly population were discussed and recorded. The final report reveals that although Scappoose is a rural community, it contains the resources available to promote successful aging in the elderly population. Pneumonia: A retrospective review of cases in 2003 at Lower Umpqua Hospital in Reedsport, Oregon Project Date: 10/18/2004 Pneumonia remains a common and deadly disease, afflicting more than 4.5 million people a year in the US alone. It is the 6th leading cause of death and the most common infectious cause. Furthermore, it has increased as a cause of hospitalization, especially among those who are above the age of 65. The population of Reedsport, OR has become increasingly older in age, and with this increase in elderly may come in increase in the prevalence of pneumonia. With other issues such as lack of adequate influenza vaccine, increased health care costs, and increased antibiotic resistance, small independent community hospitals such as Lower Umpqua are faced with numerous future challenges in care for its patients. This project, which will study pneumonia cases over the time period of January 1, 2003 to December 31, 2003 at Lower Umpqua Hospital (LUH), will allow for a review of aspects of presentation, diagnosis and treatment of this sometimes fatal disease. Goals of this project include identifying demographics of patients presenting with pneumonia to LUH, identifying co-morbidities, identifying diagnostic strategies utilized by admitting physicians, identifying strategies of treatment, and determining outcome of treatment choices. Finally, I hope to compare results of my data to national standards or other retrospective studies of pneumonia over a selected time period. Data examined in this project include month of presentation to LUH, patient demographics (sex, age), co-morbidities, diagnostics (symptoms, signs, labs, imaging), localization, tests of bacteriology (sputum, blood), aspects of treatment, length of stay, and eventual outcome. The hope is that these results will be used as a baseline for future comparisons of the incidence of community and nosocomial acquired pneumonia at LUH, will allow the admitting physicians to see trends currently employed in diagnostics and treatment at their hospital, and finally a way to determine if patients at LUH are currently receiving the most efficient and effective treatment as defined by national organizations as the American Thoracic Society and the Infectious Disease Society of America. Availability of Health Care in Warm Springs, With a Focus on the Elderly Project Date: 10/18/2004 Warm Springs is a small Native American community in central Oregon, located on the 640,000 acre reservation. The reservation is populated by The Confederated Tribes of Warm Springs, which consists of the Wasco, Warm Springs, and Paiute tribes. The tribe built a comprehensive Health and Wellness center that is utilized by the Indian Health Service for direct medical and dental care. Currently, the clinic serves an annual patient population of 5,750 through an array of specialty clinics, classes, and social services. One of the specialty clinics is a senior clinic that was recently implemented to accommodate specific health problems and concerns of the tribal elderly. Many of the native elderly population are chronically ill and mortality in the elderly is high, despite free and high quality health care. When HIS explored obstacles for seniors to receive health care, they revealed that seniors were consistently missing their appointments for reasons that could be remedied. The specialty clinic was designed to reduce total senior clinic appointments, aid in senior transportation, and coordinate the senior’s specific health care plan. Investigation into improvement in disease prevalence or improvement in health, since implementation of the senior clinic, has not yet been done. However, it is impressive to note that now more than 90% of seniors attend their Senior Clinic appointments. As the senior clinic continues to be used, it will be interesting to note possible changes in the health of the seniors as well as in the attitudes of elderly, ideally taking accountability and control over their health. The rising cost of prescription medications continues to impact the lives of many individuals. Project Date: 9/13/2004 The rising cost of prescription medications continues to impact the lives of many individuals. It is one thing to hear that prescription medications are expensive, it is quite another to put a name and a life to the out-of-pocket cost than an individual has to pay in order to maintain health. The majority of prescription medications are utilized by individuals greater than 65 years old. In the retirement community of Florence, individuals 65 years and older represent 35% of the population and also represent the fastest growing group of individuals. In order to better understand the impact of the price of prescription medications on the elderly population of Florence, the aims of this study were to 1) determine the average out-of-pocket price of medication for individuals on Medicare or Private insurance; 2) research the price of commonly prescribed medications; and 3) to conduct a survey in order to better appreciate the impact of the cost of prescription drugs on patients in Florence. This experience not only helped me to become more aware that simply writing a prescription for a medication was not necessarily going to mean that a patient was going to be able to take the medication. Lastly, through observing patients as well as my preceptor, I learned that there are alternative ways to obtain prescription medications in order to ensure that patients are able to receive the medicine that they need to maintain health. The Pneumococcal Polysaccharide Vaccine in Reedsport, Oregon Project Date: 9/13/2004 Pneumococcal infection causes an estimated 40,000 deaths annually in the United States, accounting for more deaths than any other vaccine-preventable bacterial disease. Approximately half of these deaths could be potentially avoided through the use of the pneumococcal polysaccharide vaccine. The highest mortality from pneumococcal infection occurs among the elderly and patients who have underlying medical conditions (Center for Disease Control and Prevention (CDC) 1997). The purpose of this community health project was to estimate the percentage of high-risk patients at Dunes Family Health Care (DFHC) who are vaccinated, and to develop an educational tool to help raise awareness of the dangers and ways of preventing Pneumococcus. The project consisted of a chart review of one hundred seventy high-risk patients, a questionnaire for DFHC physicians, and an assessment of resources available through the Douglas County Health Department. Based on the data obtained, a patient pamphlet was created for DFHC physicians to review and distribute. Exercise in the Elderly in Benton County Project Date: 8/9/2004 Exercise in the elderly (>65 yo) has tremendous benefits for cardiovascular disease, diabetes, osteoporosis, osteoarthritis, neuropsychological health, and cancer. Philomath presented a challenge in mobilizing elderly for exercise with few facilities for exercise. The first part of this project was to discover if people were exercising and were they exercising enough. Secondly, to discover the types of exercise people were doing and their motivation to exercise. Lastly, with that data, mobilize the population to exercise. A survey was used at Fitness over 50 and philomath Family medicine to look at amount of exercise, motivation for exercise, types of exercise and barriers to exercise. The owner of Fitness over 50 was interviewed to understand his unique model and meeting attended at city hall to learn about a future Senior Center. The exercise group averaged 3.9 days of exercise a week at 53.4 minutes a day and the Philomath group averaged 3.3 days a week at 35.9 minutes a day. This data suggests that the population not exercising doesn't come to the physician's office frquently for annual checkups. Therefore in oder to reach the population, prevention has to extend beyond the clinic. With the data an exercise "prescription" was formulated to hand out to patients. Assessment of services available to seniors in Baker City, Oregon Project Date: 7/5/2004 The population of those over 65 in the United States is rapidly expanding, a trend that has profound implications for health care practitioners and organizations serving seniors. Rural communities in particular are seeing a surge in this population. Observation of physicians in Baker City, Oregon and their interactions with elderly patients demonstrated that primary care practitioners are often called upon to connect seniors with appropriate resources, both medical and social. Navigating the numerous agencies and trying to determine which services are provided can be frustrating for physicians, seniors and their families. A survey of services available to seniors was conducted, as well as interviews with organizations providing resources. It was concluded that while there are a multitude of opportunities for seniors in Baker City, a large portion of seniors were not making use of se services. Although there are a number of reasons for this, it is hypothesized that utilization of services may increase if health care providers are able to more easily access contact information. In order to aid practitioners in this endeavor, a comprehensive list of services for seniors in the Baker City area was produced. The Ontario Aquatic and Fitness Center Project Date: 5/10/2004 Intro: The Ontario Aquatic and Fitness Center offers opportunities for people of Malheur County to swim, lift weights, or participate in water aerobics. After arriving in Ontario, it was mentioned that funding for the center was in jeopardy. After talking with my preceptor, individuals at the center, and other local health care professionals, I decided to create a usage survey for the facility to try to help determine who was using the center and for what specific reasons. Materials/Methods: A simple survey was designed asking for age, city of residence, average number of visits to the center in a month, and the main reason for the visit to the center. Five options were listed to select from for the main reason for the trip to the center. Results: 67.4% of the respondents used the center for water aerobics, which was indicated as their main form of exercise. Average age of this group was 67, with an average number of monthly visits of 12.3. The next largest group (18.4%) used the center for its gym, which was the main place they worked out. Average age was 39.6, with average monthly visits being 15.7. The remaining groups were those using the center for water aerobics, which was not their main form of exercise (10.2%), for physical therapy (2.0%), and for recreational swim (2.0%). Conclusions/Discussion: The results of the survey indicated that the center was utilized mainly by the geriatric population for water aerobics, which was their main form of exercise. The gym was used as a main work out facility by another large group, who tended to be of a younger generation. Average number of visits per month by each group was impressive. Given the benefits of exercise in several medical conditions, such as hypertension, diabetes, and osteoporosis, the center is serving a beneficial role in the health and well-being of many of Malheur county’s residents, particularly the elderly. Screening for depression in the elderly Project Date: 5/10/2004 Objective: To evaluate depression among individuals over the age of 65 presenting the primary care setting. Methods: The 15 Geriatric Depression Scale (GDS) was distributed to both Spanish and English speaking patients in the primary care setting. The question also included demographic information to identify possible risk factors for depression in the community being evaluated. Patients' Views About End of Life Care in an Aging Population Project Date: 9/29/2003 Physician-assisted suicide was legally enacted in 1997 in Oregon. One year later in 1998, a survey was taken of patients in Reedsport, OR examining opinions about physician-assisted suicide. Since then, a significant demographic change has occurred, shifting the mean age of the population upwards. This project studied patients’ attitudes and knowledge base about end of life care in this aging community, including both physician-assisted suicide and hospice care. Assessing Reaction Time: A Screening Tool for the Rural Clinic Project Date: 8/18/2003 Recent headline news around the nation has indicated that the elderly population is not safe behind the wheel. The recent increase in automobile deaths involving elderly divers has prompted the insurance companies to demand their elderly patients be objectively evaluated by their physicians. Many of these forms require evaluation of the patient’s vision, eye sight, seizure disorder, chronic illness, reaction time, etc. All of these being relatively quick and easily objectively evaluated in the small rural clinic, except for reaction time. An inexpensive reliable measure of a patient’s reaction time doesn’t currently exists. My study was designed to study the effectiveness and reliability of a 30 cm ruler drop with the determination of the population mean and standard deviation for reaction time. Statistical analysis of 75 patients reaction time suggested that the 30 cm ruler drop when compared with an 8000 subject study using a computerized test considered the “gold standard”, was reproducible and a sensitive method for determining a subjects reaction time. The suggested use of the 30 cm ruler drop is to use it to determine patients reaction time and report this number on insurance forms. It is also suggested that it be used as a screening tool only, and should not be used as grounds removal of automobile licensure. A person scoring 2 standard deviation outside the population mean should be referred to a testing facility for more extensive evaluation. Guidelines for the Assessment of Driving Capacity in the Elderly Project Date: 8/18/2003 As the elderly population continues to grow in the United States, physicians are acquiring the difficult task of assessing their patients ability to drive. Physicians frequently encounter questions regarding an individual's driving capacity. However, many doctors are not aware of resources available to help them in their assessment. Moreover, state requirements vary significantly. Most states have permissive reporting laws regarding the doctor's role in medical evaluation and managment for fitness to drive. Such laws offer physicians little guidance and may put doctors at risk for lawsuits if they report a patient to the Department of Motor Vehicles (DMV). Seven states, including Oregon, have mandatory reporting laws. In these states, a doctor may risk legal action for not reporting a patient. The purpose of this project was to elucidate helpful guidelines for rural doctors with geriatric patients in assessing fitness to drive. Another goal was to determine how a rural community affects this decision. A Philomath Senior Center * Wellness Program * Project Date: 7/7/2003 Abstract: Many communities have developed senior centers to serve the diverse needs of their elders. They are as varied as the communities and seniors that they serve. Senior centers help keep older people active, healthy and independent while strengthening the web of relationships between individuals and their communities. Many, many types of activities and programs are available at senior centers, depending on the local context, needs and interests. These include health and wellness programs such as support groups, informational talks, and various clinics. The level of programming varies considerably. Philomath presently has no senior center, but a group of local people is working to change this. They hope to restore the historic College of Philomath building and have proposed this as a home for a local Philomath Senior Center. The project is just in the beginning stages but energy is gathering for addressing the questions and doing the work. They would join thousands of other communities who have developed and maintain a local senior center. Identifying senior services available in John Day, OR and making those services known to seniors and families caring for the aging in John Day and Grant Co. Project Date: 5/5/2003 The nations population of people over age 65 has grown and will continue to grow in the coming years. Many people in this age group need assistance with health and daily activities and communities are having to find ways of providing assistance and educating the public about those assistance programs. This community project attempted to identify the senior services available in John Day, OR and make those services known to seniors and families caring for the aging in John Day and Grant Co. The design was observation of medical staff’s identification of senior patient’s needs and the referral system for those patients and families to senior services. Patient and staff knowledge and utilization of senior services was also observed. There are many resources and contacts available for seniors in John Day and Grant County, but no concise compilation of information for those needing senior services now or in the future and a noted under utilization of some services. There is a mechanism in place for identifying people in need of senior services, but it is mainly used only for hospitalized patients and it was felt that the rest of the medical community and general population would benefit from knowledge of the senior services available in the community. The only handout readily available was geared more for hospital and nursing home staff to use or give to those patients and families in those settings. Furthermore, the handout was more of a listing of phone numbers and details betters utilized by the medical community than the general population. Therefore, the final product of this project was development of a concise handout to be, given to patients and families in the clinics, hospital emergency room, and newcomers and the general population via the chamber of commerce. Increasing Access And Affordability Of Prescription Drugs For Medicare Patients In A Rural Health Setting Project Date: 2/10/2003 Affordable access to prescription medications is a problem for many elderly patients in the United States. For elderly persons living in rural communities the problem seems to be even greater - there seems to be a certain negative synergy between being elderly and living in a rural setting when it comes to drug access. To top it off, rural health clinics lack the typical interdisciplinary teams seen in some urban clinics. By not having a social worker or volunteer who might help patients decipher drug discount programs, health care workers are called to wear many hats, all in a nine-to-five workday. This project aimed to identify what characteristics about elderly rural patients make them vulnerable to decreased access to affordable drugs. The next step attempted to identify what one rural health clinic was doing to increase access. Extensive research was conducted on the available programs for cost savings on prescription drugs. Finally, a revised program was designed to increase access and affordability for patients and hopefully increase efficiency for the health care worker. Awareness of Osteoporosis in an Elderly Population in Tillamook, Oregon Project Date: 12/30/2002 Osteoporosis represents an important public health problem. The prevalence of this disease and its complications are particularly high in the elderly population. This study attempted to evaluate the level of knowledge and awareness of osteoporosis in a rural community that has a large proportion of senior residents. The second objective was to compare differences in the knowledge level between men and women and identify their source of information. Participants, 18 men and 27 women with an average age of 75 years, were invited to complete a questionnaire. Ninety-three percent of subjects were aware of osteoporosis and 75% gave the correct definition. In contrary to the general thinking that men are not as well aware of osteoporosis as women are, there was no difference in the levels of knowledge between the two sexes. The sources of information used by the two groups were different. Men relied most on television whereas women obtain information from their doctors. The main risk factors for osteoporosis reported were low vitamin D and calcium intake and lack of exercise. These data showed a high level of awareness of osteoporosis in this elderly population in Tillamook. Adult Foster Homes in Philomath, Oregon. A survey of services offered, population served, and the licensing requirements of these institutions. Project Date: 9/23/2002 With the aging of our population comes an increasing need for more long-term care facilities. Adult foster homes (AFH) were spawned from the need for facilities that could provide quality care in a less institutionalized setting at a reasonable cost (about two-thirds the cost of nursing home care). Philomath is a small town of approximately 4,000 inhabitants, which is located in Benton County. Benton County has a population of 77, 929, 10.3 % (8026 individuals) of this population is 65 or older. There are two adult foster homes in Philomath, His House and Heaven's Half Acre. The goals of this project were to first identify what role these adult foster homes play in Philomath and the surrounding communities, to understand the services offered and to finally identify licensing and requirements for licensure. These goals were met via interviews with the Benton/Linn County AFH licensor and with the providers at the homes in Philomath. The findings of this study illustrate that AFHs provide long-term care to those with Activities of Daily Living (ADL) impairment. The homes in Philomath serve primarily the elderly (65 and older) and, occasionally, younger disabled individuals from Philomath and its surrounding cities. There are three levels of AFH, which provide progressively higher acuity of care. His House is a level III AFH and Heaven's Half Acre is a level II AFH. Adult foster homes must comply with regulations formulated by the state legislature, which are enforced through the local Senior Services Division in Albany by the AFH licensor Colleen Susac. Through the interviews conducted some gaps were identified in the services offered by adult foster homes, these are discussed throughout the paper. Medical Triage Guidelines for an Assisted Living Facility in John Day Oregon Project Date: 2/11/2002 Inappropriate use of the ambulance and emergency room by the staff and residents of Valley View assisted living residence was identified as source of frustration among the physicians of John Day. The cause of this problem is the very limited medical training of the med aid staff at Valley View. An algorithm consisting of a series of simple yes/no questions was proposed as a triage system that would match the medical training of the staff at Valley View to the expectations of the local physicians. The triage algorithm was presented to the staff at Valley View and is being implemented on a trial basis. Once the Valley View staff have become comfortable with the tool and it has been in use for several months the local physicians will be polled to evaluate the triage system's effectiveness. Preventative Care And Management Of Risk Factors In Elderly Patients With COPD In Florence, OR Project Date: 1/2/2002 In the United States, COPD is the fourth leading cause of death. This retrospective study sought to examine preventative care practices and management of risk factors in elderly patients with COPD from the internal medicine clinic at Health Associates of Peace Harbor in Florence, Oregon. Endpoints examined included prevalence of smoking, annual influenza vaccination, and diagnosed depression. 21% of patients in this study were current smokers, and almost all had documented evidence of being advised to quit by their physician. 23% had received an annual influenza vaccination. 14% of patients had been diagnosed with depression, and almost all had documented evidence of treatment with pharmacologic therapy. This report discusses the need for development of improved comprehensive care for elderly patients with COPD and offers specific suggestions, including utilization of numerous community resources as a way to facilitate patient participation and development of a therapeutic alliance. Assessment Of The Signs And Symptoms Of Acute Myocardial Infarction Of The Elderly In The Emergency Setting In Reedsport, Oregon. Project Date: 1/2/2002 The purpose of this study was to examine elderly patients who presented to the emergency department (ED) in Reedsport, Oregon for symptoms of acute myocardial infarction (AMI). The objective was to determine what diagnoses were ultimately found for these persons, and then to determine if the presenting signs and symptoms of the elderly with a discharge diagnosis of myocardial infarction (MI) were representative of the national average. The ultimate goal was to determine whether the elderly with AMI are being underdiagnosed in Reedsport, and, if so, can improvements be made to diagnose them? A case review was done of approximately one year's prior time of all persons greater than 70 years of age presenting to the emergency room (ER) with symptoms of AMI. These cases were reviewed for chief complaint, associated symptoms, electrocardiogram (ECG), cardiac markers (Troponin-I, CK-MB, and myoglobin), and other various findings. It was found that 9% of subjects selected were ultimately diagnosed with an AMI. 35% had other cardiac problems (13% related to angina and 22% related to non-ischemic etiologies), and 56% had diagnoses unrelated to cardiac origin. The ECGs, cardiac marker findings, and other studies are described. It is thought that due to limitations in specificity and sensitivity of the ECG and cardiac markers, but moreover, the prevalence of atypical presentations of AMI in the elderly, that it is possible that a number of MIs in the elderly are not being diagnosed in Reedsport. Recommendations for improvement are given. Staying Active and Correlates to Geriatric Depression in Florence. Project Date: 9/24/2001 An attempt was made to understand the nature of geriatric depression in a small coastal town in Oregon. The study was originally formulated with the hypothesis that a casusal link exists between lack of meaningful social activity and depression. Patients 65 years and older that have been diagnosed at one time with depression were selected from among the patients of a local internal medicine physician. These patients were interviewed in depth about their present and past level of involvement in social activities, limitations on participation in activities, degree of social isolation, living situation, palliative/aggravating factors, and use of antidepressant medications. Following the interviews, the link between level of activity and depression was found to be complex. As a supplement to the study, a detailed list was compiled of area services for seniors, meal programs, interest and support groups, social activities, and volunteer opportunities. This information was organized into a pamphlet, which was mailed to those participants that indicated interest. It was also made available to staff in the physician's office and to discharge planners at the local hospital. Improving The Quality Of Life For An Aging Population: An Analysis of the Accessibility and Availability of Services for Seniors in Benton County, Oregon. Project Date: 9/24/2001 Almost 13% of the population in the United States and 10.3% of the population in Benton County is over the age of 65. Studies predict that the 65+ age group will grow by 135%, while the number of people who are 85+ will grow by 401% by the year 2050. With this incredible rate of growth, the demands on society to develop specialized services that provide assistance for the elderly are profound. The needs of the elderly are extensive and include assistance with the activities of daily living, housing, transportation, nutrition, health care, social interaction, financial assistance, support groups, and end-of-life care. The purpose of this project was to analyze the availability, accessibility, quality, and use of services provided for seniors within Benton County, Oregon. The results of the study show that there are many, high quality services within Corvallis. These services appropriately address many of the needs of seniors and most of the services have an excellent rate of participation. However, several areas of weakness were also found that may prevent many seniors from accessing these services. These included the lack of a central resource agency, extremely high costs for many of the services, lack of an adequate transportation program, lack of adequate resources in rural communities surrounding Corvallis, and a limited number of resources for individuals who do not have a high level of function. If these areas are not addressed, the pressure of the aging population on Benton County may prevent many seniors from receiving a number of services that are required to provide dignity, respect, and a high quality of life. Back to subject search page or search by preceptor site