FOCUS on Geriatric Medicine

Dr. Lee Jennings

Dr. Lee Jennings knew that she was meant to work in geriatrics when she was a medical student.

“Even through those exhausting days, I still really enjoyed talking with my older adult patients. I could make a difference,” said Jennings, chief of the University of Oklahoma’s Donald W. Reynolds Section of Geriatric Medicine.

Today, Jennings is paving the way for a new model of care benefitting vulnerable older adults via the Oklahoma Dementia Care Network, or OkDCN. The statewide program is aimed at improving health education and community outreach for older adults living with dementia.

OkDCN offers an array of training and resources to primary care providers, patients and caregivers, said Jennings, a Donald W. Reynolds Chair in Geriatric Medicine whose research is in the field of health services.

“I focus on how care is delivered in health systems and what we can do to improve health-care delivery and therapy, thereby improving outcomes for patients and families,” she said.

Through OkDCN, Jennings’ team is improving the workforce readiness of senior health care, leading a project to reduce opiate-use disorder and improve chronic pain management in Oklahoma primary care practices, and coordinating a tele-mentoring project teaching best practices to staff members at nursing homes and assisted living facilities.

Jennings and her team have attracted more than $13 million in federal funding since she came to OU in 2016. She said the seeds of their success are rooted in the Donald W. Reynolds Foundation, which gave more than $20 million to the OU Foundation to benefit geriatrics research, teaching and programming. As intended, the Reynolds Foundation spent its resources and closed in 2017.

Jennings’ endowed position was one of 10 established in geriatric medicine through the Reynolds Foundation gifts and made it possible for her to choose OU. “Having an endowed chair provided me with start-up funds to continue some of the work I had begun at UCLA,” she said.

Among that work is evaluating outcomes of a national dementia care team model that Jennings hopes to bring to OU Health.

The Alzheimer’s and Dementia Care Program provides wrap-around services by connecting patients with a nurse practitioner who specializes in dementia care management. The nurse practitioner can prescribe medications and make recommendations about treatment options in conjunction with the patient’s existing primary care physician.

“They’re dementia care champions,” Jennings said, adding that the nurse practitioners are available 24/7 by phone. “The design is focused on getting people appropriate care and having avenues for access outside of business hours, because emergencies don’t always happen from 8 to 5.”

She said the program started at UCLA and is now available at 13 sites across the nation. Jennings can see a future in which OU Health also would offer a memory-evaluation clinic and dementia care program.

“We could help people who have cognitive concerns and memory problems get the proper diagnosis they need and link them to comprehensive care so that people can live with dignity throughout this disease,” she said.

An OHAI educator leads older adults in a tai chi class intended to improve balance and reduce falls.

Older adults from across Oklahoma are healthier and safer through the generosity of hundreds of small gifts to the Oklahoma Healthy Aging Initiative Fund at the University of Oklahoma Foundation.

The fund supports OHAI, a statewide network in OU’s Donald W. Reynolds Section of Geriatric Medicine. OHAI offers a wide range of resources and healthy aging educational programs aimed at improving the lives of older Oklahomans and their caregivers.

Since its 2013 founding, more than 16,000 Oklahomans in 200 communities across the state have been served through OHAI. All classes are free, thanks in part to the OHAI fund and federal grants.

“Accessibility has always been a philosophical tenet of OHAI,” said associate director Keith Kleszynski, an assistant professor in geriatric medicine.

OHAI educators offer services from regional offices in Durant, Enid, Lawton, Oklahoma City and Tulsa. Among the most popular are the fitness courses “Tai Chi: Moving for Better Balance” and “Staying Active and Independent for Life.”

“Tai chi is the ‘gold standard’ that has been scientifically proven to improve balance and reduce the risk of falling,” Kleszynski said.

OHAI also offers programs for caregivers, including online courses. “Doing the courses on Zoom is sometimes better for the caregivers because they can log in from home while the person they’re caring for is present,” he said.

In addition, OHAI educators provide presentations on topics of special interest to older adults, including diabetes management, eye health, mental health and medication management.

During the height of the pandemic, courses and programs were offered virtually. OHAI is returning to in-person events through longtime collaborations with local community and senior centers, libraries, and assisted living and nursing homes.

“One of the special things about our programs is that we go where people are. OHAI educators are also from those regions and understand the nuances of life in their communities,” Kleszynski said. “All of our educators are affable people who care very much about older adult health and well-being.

“But, the virtual options are here to stay, as they are useful for older adults who may not be able to get out of their house. We also hear from people, ‘If not for OHAI, I wouldn’t have used Facetime or Zoom in a million years, but now I’m glad that I did, because I can connect with my family.’ ”

OHAI’s fitness classes can be modified to meet individual needs, such as for those who use wheelchairs or are unable to stand for extended periods, and participants frequently take the 12-week course multiple times. “There’s an organic camaraderie and community that comes out of the classes,” Kleszynski said.

Through a survey, one participant from the Enid site shared, “If you offered this class five days a week, I would come to all of the classes,” while another related what a difference the course has made in their mobility.

“I go to OU football games, and I was looking for a lightweight walker to get from my car to the shuttle and my seats,” they wrote. “I now do just fine with my cane.”

Leena Almasri

America’s population of older adults is growing rapidly. But the number of health professionals trained to serve this changing demographic has not kept pace.

“Aging is not a disease, it’s a state of health,” said Lazelle Benefield, director of the University of Oklahoma’s Reynolds Center of Geriatric Nursing Excellence at the Fran and Earl Ziegler College of Nursing.

According to the Administration for Community Living’s 2020 Profile of Older Americans, the number of adults 65 and older increased 36% from 2009 to 2019. In Oklahoma alone, the population has grown by 27%.

“We have a population that is continuing to be healthy for many more years than in the past. With that comes the need for expertise understanding the unique and special needs of people who are older,” Benefield said.

In 2017, the Donald W. Reynolds Foundation invested in building that expertise through a nearly $9 million gift to the OU Foundation. The gift represented the only nursing initiative that the Reynolds Foundation supported nationwide.

The Reynolds Center of Geriatric Nursing Excellence Fund provides scholarships up to $150,000 over three years to two outstanding OU students earning a Ph.D. in nursing science with specialization in geriatrics. Benefield said such support significantly shortens the seven to 10 years that many doctoral students require to finish their degrees while also working.

“Most people don’t have the financial resources to cut back to half-time work or less while earning a Ph.D.,” she explained, adding that the OU program’s online format also allows it to serve adult students from across the state. “These funds give them the ability to maintain full-time study and accelerate through the program, and for OU to quickly move highly qualified nurse leaders into the field.”

Scholarship recipients will promote improvements in geriatric health through careers ranging from research to policy and leadership, teaching, and managing health care systems, said Benefield, who also is a professor and dean emeritus of the college.

Leena Almasri, a fourth-year Ph.D. student living in Norman, hopes to continue her work as a geriatric researcher. She currently is exploring how the immune systems of older adults with diabetes and living in nursing homes have responded during the COVID-19 pandemic.

“I have found my passion in research,” she said. “I love collecting and analyzing data.”

Almasri said the Reynolds scholarship has made it possible for her to balance raising a family with earning a Ph.D.

The program also provides her with special opportunities to attend national conferences and brings students together monthly with prominent researchers called “examplers,” Almasri said.

“This is a great chance to interview scientists with high-impact work and strong reputations in specific areas of research while sharing our research with them. There’s an increasing demand for research within geriatric nursing,” she said. “Older adults need more attention, and we need to address the challenges that they face.”

“The Reynolds Center of Geriatric Nursing Excellence Fund has provided OU College of Nursing doctoral students with opportunities to contribute to improving health care for older adults, facilitate aging in place and advance the science of aging,” said OU College of Nursing Dean Julie Anne Hoff.

“Our students, college and community-based stakeholders across Oklahoma and beyond have benefited from Dr. Benefield’s vision for healthy aging.”