Schmeiding Center for Senior Health and Education, Springdale

There are eight such centers in the state that are a collaboration between the University of Arkansas for Medical Sciences (UAMS) Donald W. Reynolds Institute on Aging and local community hospitals.

The centers provide two things:

• Education on health and aging to healthcare professionals, and individuals including older adults and their families.
• Interdisciplinary healthcare to older adults that is unique, led and driven by geriatric specialists.

“Many older adults have so many problems and are taking so many medications that they don’t fit well into the schedule of a busy primary care physician because these patients take a lot more time,” said Larry D. Wright, MD, a geriatrician who is executive director of the Schmeiding Center for Senior Health and Education, Springdale and medical director for senior health for Northwest Health System. “They deserve a lot more time. They present with problems weighed toward geriatric syndromes, problems unique to disabled older adults, which are very difficult to manage in a typical primary care physician’s practice.”

Primary care physicians are under a lot of stress already. So when the Centers on Aging can serve as consultants lightening the load for primary care doctors, it can be very helpful.

“The American healthcare system does not provide what these older adults need the most,” Wright said. “When at risk and frail, patients need more time and attention from physicians. But that isn’t what Medicare is paying for. Especially when they develop problems that are difficult to figure out, it takes a team process.”

One critical service provided at the centers is memory evaluation. Geriatric neuropsychologists can provide an evaluation to determine if the patient’s memory loss is dementia or another problem that is reversible.

“It not only gives a definitive diagnosis, but in the case of dementia will tell us what type of dementia it is, which certainly has implications for treatment,” Wright said. “Another way the centers can be a resource to primary care professionals is with any kind of functional decline. Many elderly patients present declining functionally, but it is not specific. If it continues, the patient will be disabled and possibly in a nursing home. To determine the problem and potential treatment takes a comprehensive evaluation.”
Wright said that knowledge about the Arkansas Aging Initiative is “still a pretty well kept secret within the medical community.” But the initiative has been getting quite a lot of attention nationally. A grant from the Reynolds Institute is being used to replicate the program in New York and Oklahoma.

“The Reynolds Institute on Aging has set something in motion that is a really good model,” Wright said. “It is successful clinically not only because it serves older adults and their families, but also their primary care physicians.”

Gretchen Orosz, MD, a geriatrician who is director of the West Central Center on Aging in Sparks, and medical director of the Sparks Senior Health Center, said the programs help take better care of the state’s aging populations.

“We have been able to keep patients in their local areas without having to go to Little Rock for geriatric care,” Orosz said. “In addition to that, we have been able to provide education out in the communities to patients, family members and other healthcare providers on issues related to aging and the care of aging patients. Now in all areas we have geriatricians taking care of older adults, and are able to help other providers who don’t have advanced training in the care of the elderly. We also have additional educational programs to improve their care of older adults. There are not enough of us to go around, so the more we can do to educate other providers and assist them in this care, the better it is for them and for the patients.”

While the more intensive services can cost more up front, they can save not just pain and suffering, but money in the long term. For example, patients receiving the care tend to have a shorter length of stay and lower costs when hospitalized.

“This is a very unique program,” Orosz said. “I came from a major academic medical center in New York City well known for geriatric care. I was attracted to the program here in Arkansas because there is nothing like it elsewhere. It is a statewide program that does amazing work.”

“It is incredible what the university has done in terms of rural aging programs,” said Claudia Beverly, PhD, RN, director of the Arkansas Aging Initiative. “The Arkansas Aging Initiative came about because of the tobacco settlement dollars. We are the only state using our money in this way. The Reynolds Foundation has given a $4.5 million grant to Oklahoma University to replicate the Arkansas Aging Initiative in Oklahoma. We are very proud of that. And we are now in discussions with the State of New York to begin looking at how this could be implemented in pilot testing in New York. It is exciting to see there is interest in what we are doing here.”

The eight centers are: West Memphis (Krittenden Memorial), Jonesboro (St. Bernards Medical Center), Pine Bluff (Jefferson Regional), El Dorado (Medical Center of South Arkansas), Texarkana (Christus St. Michael’s), Fort Smith (Sparks Regional Medical Center), Springdale (Northwest Health Systems) and Hot Springs (Oaklawn Senior Health Care Center). Oaklawn has only an educational center, not a clinic.

In addition to the clinical services provided in cooperation with local hospitals, the education part targets four different population groups:

• Health providers around the state.
• Health care and social service students.
• Older adults and their families.
• General community members served with activities such as programs on healthy cooking.

About 70 percent of older Americans have one or more chronic disease. So the Arkansas Aging Initiative has focused a lot on how to manage chronic disease to prevent further deterioration.

“Chronic disease is a huge cost to Medicare, and we have to get a handle on that with so many baby boomers coming along so we can continue to provide high quality healthcare to older Americans,” Beverly said. “In Arkansas we have 22 to 23 master trained individuals in what is known as Stanford chronic disease self management program. That program is designed to help older adults with a chronic disease know how to take care of themselves. The focus is on individuals taking responsibility for their own healthcare. It is a six-week course. People who have gone through this tell us how much it has meant to them to better understand what is going on with them so they can do a better job taking care of themselves.”

One important role of the centers involves using a team approach. Beverly said it is amazing how many medicines older people are taking. That can cause problems from drug interactions.

“When have pharmacists involved, they try to keep it to six to eight medications,” Beverly said. “By having the team approach, that team knows everything going on with that patient. They can make sure medicines are not contraindicated. This team is also available to families, because they have so many questions, particularly as a loved one gets more ill. There are so many decisions to make and the team is there to help them.”

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