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Item Increasing POLST completion in patients 65 and older: a primary care quality improvement proposal(Montana State University - Bozeman, College of Nursing, 2024) Troxel, Katherine Denali; Chairperson, Graduate Committee: Margaret Hammersla; This is a manuscript style paper that includes co-authored chapters.The Physician Order for Life Sustaining Treatment (POLST) is a signed medical order, relied on when an individual is unable to communicate, or unaccompanied by a healthcare proxy; POLST protects individuals with active preferences to waive default life support interventions (Turnbull et al., 2019). Adults aged 65 and older require more emergency services than any other demographic, yet only 20% of injured adults requiring emergency transport have a POLST at the time of 911 contact (Zive et al., 2019). 25% of patients aged 65 and older receiving primary care at a rural, western Montana clinic have a POLST in the electronic medical record (EMR). A literature review of POLST expansion into the non-acute care setting was conducted to create a clinic workflow for POLST completion. Eight primary care providers were issued a discussion framework and EMR documentation aid. Number of new POLST were captured from the EMR bi-weekly. Patients 65 and older presenting for an annual wellness visit (AWV) were screened for POLST in the EMR. Provider offered POLST completion for those without and documented discussion regardless of completion. Those not ready to complete POLST were sent home with the document and offered a 2 month follow up appointment to complete it. 10.8% of qualifying AWVs (n=37) during the 30-day study period resulted in POLST completion. Provider guided POLST discussion promotes patient centered care in the event of an emergency. A longer study period, built-in EMR reminders, and an on-site POLST leader may increase metric compliance.Item Increasing the PPI deprescribing rate at a transitional care unit(Montana State University - Bozeman, College of Nursing, 2023) Yu, Linfei; Chairperson, Graduate Committee: Sandra Benavides-VaelloBackground: PPIs are overprescribed worldwide, especially among geriatric populations. The long-term use of PPIs is associated with many adverse effects. This project aims to utilize deprescribing algorithms to assist healthcare providers in deprescribing inappropriate PPI prescriptions for patients at a 17-bed transitional care unit within a skilled nursing facility. Methods: The seven-step method problem-solving model was used for this project. Baseline assessment included a review of patient electronic medical records (EMRs) two months before the intervention. Admission and discharge notes were reviewed to identify the baseline rate of patients with PPI prescriptions and the deprescribing PPI rate by discharge. A review of the literature review was conducted to identify interventions that focused on providers deprescribing PPIs. A review of EMRs two months post interventions to identify PPI deprescribing rate. Interventions: Education, including the provision of the deprescribing algorithm, was provided to address the knowledge gap. A post-education survey was completed by providers to identify readiness and motivation levels for deprescribing PPIs. Patient education pamphlets regarding PPIs were made to enhance the success rate for deprescribing PPIs. Education was also provided to nursing staff to help distribute PPI education pamphlets to patients and remind healthcare providers to review PPI prescriptions. Results: Zero healthcare providers responded to the readiness survey. Following the interventions, 5 patients out of 20 on PPIs were deprescribed, compared to 0 out of 11 patients before the interventions. The five patients were deprescribed from PPIs by the same healthcare provider who responded to the follow-up emails after interventions. Conclusions: The project's objectives were not achieved due to healthcare providers' lack of response to the readiness survey, and the deprescription rate was 25% postintervention at TCU compared to the aim of 30%. To improve the chances of success in future QI projects, it is recommended to encourage the participation of healthcare providers and nursing staff through face-to-face education and allow more project time to thoroughly evaluate the impact of chosen interventions.Item Design, fabrication, and validation of a portable perturbation treadmill for balance recovery research(Montana State University - Bozeman, College of Engineering, 2022) Knutson, Robert George; Chairperson, Graduate Committee: Corey PewTrips and falls are a major concern for older adults. The resulting injury and loss of mobility can have a significant impact on quality of life. An emerging field of study, known as Perturbation Training, has been shown to reduce injury rates associated with trips and falls in older adults. In a typical training session, the user stands or walks on a treadmill and is subject to sudden, unexpected accelerations, simulating a trip or slip, in a safe environment. This training aims to improve the user's ability to maintain and recover balance in situations that can often lead to falls. Treadmills traditionally used for Perturbation Training are large instrumented devices that are rigidly bolted to the floor. This presents a problem for older adults with limited mobility or those who live far away from Perturbation Training facilities. A portable treadmill would be able to serve a larger portion of the at-risk population then current methods have allowed. We developed a portable, low-cost perturbation treadmill capable of high-intensity training. The system can perform trip and slip perturbations from a stationary or walking state. It features a tandem belt configuration, a small gap between belts, and individual belt control. The belt speed is digitally controlled, dictated by a custom human-machine-interface and software suite, which allows operators with no programming experience to control the device. When connected to a 240-volt power supply, the maximum belt speed is approximately 3.6 m/s. The treadmill was designed to accommodate a user of up to 118 kg and provide a maximum acceleration of 12 m/s 2 under full load. The treadmill weighs approximately 180 kg and can be moved like a wheelbarrow, with handles in the back and wheels in the front. The design has been validated and was used in multiple locations in a clinical trial.Item Alternative explanations for sexual strategies theory(Montana State University - Bozeman, College of Letters & Science, 2022) Moyer, Christina Maria; Chairperson, Graduate Committee: Ian M. HandleySexual strategies theory (SST) has been one of the most popular evolutionary-based theories to explain sex-specific differences in the mating behavior of men and women. More specifically, SST states that men prefer short-term (ST) mating and higher numbers of ST partners than women, and that these differences evolved to optimize the reproductive success specific to each sex. However, research into SST has relied on a very narrow age range in most of the samples used to test its hypotheses, which calls into question the generalizability of key findings to older adult populations. Further, other psychosocial factors may significantly influence men and women's ST sexual behavior, meaning sex differences in mating preferences might result from these other factors rather than evolved sex differences in mating strategies. I tested these ideas in two samples: one in a college-convenience sample using regression analyses, and one in nationally and age-diverse sample of adults using structural equation modeling. These studies revealed that the social acceptance of women engaging in ST sexual behavior (Studies 1 & 2) and concern for personal safety when engaging with a ST partner (Study 2) were more powerful predictors of ST mating behavior than biological sex. Thus, these findings offer evidence to suggest that social and personal factors are more important drivers of human sexual behavior and cast doubt on sex differences that evolved to optimize reproduction according to SST.Item Deprescribing proton pump inhibitors, benzodiazepines, antipsychotics, and antihyperglycemic medications in a rural clinic in an elderly population(Montana State University - Bozeman, College of Nursing, 2021) Wurz, Lucas; Chairperson, Graduate Committee: Susan LuparellBackground: Polypharmacy affects many patients as they age and develop multiple health problems. The increased number of medications has been directly related to adverse drug events (ADEs) which include overdoses, falls, diarrhea, or insomnia. A panel of experts at the Bruyère Research Institute identified four classes of medications (proton pump inhibitors [PPIs], benzodiazepines receptor agonists [BZRAs], antipsychotics [ASs], and antihyperglycemics [AGs]), which are especially problematic in the elderly. They created four algorithms to help evaluate the necessity of these medications and offer suggestions for deprescribing them. Aim: The aim of this project was to decrease the unnecessary use of PPIs, BZRAs, ASs and AGs among the elderly by using the Bruyère algorithm and to increase provider deprescribing self-efficacy scores. Methods: This quality improvement project was conducted in a small rural community clinic in Northwest Montana. Two nurse practitioners (NPs) were involved. A survey was filled out by both the NPs at the beginning and the end of the project to assess their self-reported self- efficacy. A brief description of the Bruyère algorithm was provided to the NPs. This algorithm was then applied over a ten-week period to all patients over the age of 60 who had been previously prescribed the medications of interest. The rates of deprescribing as well as changes in provider self-efficacy scores (SES) were measured at the end of the project. Results: A total of 29 patients were encountered during the project. Ten of the patients were on a PPI and one was on a BZRA. None of the patients screened were on any of the other two classes of medications. At the end of the project, none of the targeted medications were discontinued, although PPI dosing was decreased from twice daily to daily in two patients. Overall, provider self-efficacy scores improved by 15% during the intervention period. Conclusions: The deprescribing algorithms likely improved provider self-efficacy scores and may reduce the medication burden faced by patients over the age of 60.Item Addressing access barriers for geriatric Montanans: a CNL approach(Montana State University - Bozeman, College of Nursing, 2022) Martini, Melissa Lynne; Chairperson, Graduate Committee: Denise RiveraRural residents experience risk factors that contribute to health disparities and lower life expectancy (CDC, 2017; Skoufalos et al., 2017). Rurality and the associated social settings of rural communities have direct relation to difficulty in accessing healthcare which is further complicated by distance and weather-related issues common to Montana. The overarching purpose of this review is to determine if the health of elderly rural Montanans is improved with the creation and use of a mobile care clinic in the community to serve these individuals. This quality improvement project will be conducted using survey's via convenience sampling of elderly members in a rural community in Montana.Item Effects of reactive balance training on joint health(Montana State University - Bozeman, College of Education, Health & Human Development, 2022) Peart, Dakota Paul; Chairperson, Graduate Committee: David GrahamFalls are a major cause of mortality and morbidity among older adults. One of the major risk factors of falls is impaired neuromotor function, which can be addressed through conventional exercise programs. While beneficial for many aspects of health, conventional training does not appear to greatly reduce the incidence of falls. More recently, reactive balance training (RBT) has emerged as a task-specific exercise that is highly effective and efficient at reducing subsequent fall rates. However, little is known about the tissue-level effects that this high-impact exercise may have on the joints of participants. Overtraining by performing RBT at excessive volumes or intensities could feasibly cause damage and degradation of joint-related tissues, potentially leading to discomfort and even post-traumatic osteoarthritis. Such processes are driven by mechanisms featuring general and tissue specific signaling molecules, and also yield tissue-specific breakdown products. To explore the possibility of joint damage resulting from reactive balance training, healthy middle-aged adults performed varying amounts of RBT, and the resulting signaling responses were observed. It was found that RBT does induce a prominent biochemical response, and the nature and magnitude of the response appears to be influenced by the volume and intensity of training performed.Item An assessment of health literacy in independent rural older adults(Montana State University - Bozeman, College of Nursing, 2019) Schubert, Tiffani Paulette; Chairperson, Graduate Committee: M. Jean Shreffler-GrantAdequate health literacy can increase an older adult's ability to manage treatment options, promotes informed decisions concerning self-care, and can play an important part in improving public health while decreasing healthcare costs. The purpose of this project was to assess general health literacy and complementary and alternative medicine (CAM) health literacy in independent older rural adults, explore their use of CAM and over the counter (OTC) medications and their sources of information regarding these therapies, and determine if health literacy and CAM health literacy levels changed based on prior experience with the questionnaire used in this project. Two questionnaires were administered to 30 rural independent older adults approximately 4 weeks apart. Descriptive statistics, paired samples t tests, and correlations were utilized for analysis. To measure general health literacy, three measures were used: Newest Vital Sign (NVS), a single question, and PEPPI. It was found that participants in this project had confidence in their ability to communicate with their provider, had average to above average general health literacy, and on average, were moderately health literate about CAM. Participants were less likely to have used CAM in the last five years than previous research and they frequently referred to their provider for information regarding CAM therapies. The majority of the participants had used OTC medicines in the last year, and mainly received their information regarding OTC medicines from their healthcare provider. There was no change in the participants' scores on the instruments used in this project with repeated exposure to the questionnaires. The results of the Health Information-Seeking Instrument allowed for the exploration of participants' tendency to seek health information. The results suggested that those participants who had a higher average income were more likely to seek health information than those with a lower annual income. This study has implications that are important to patient care. Determining the health literacy of the patient is of utmost importance in order to provide quality care to older adults. As a provider, it is important to understand a patient's health literacy level and to monitor this level over time.Item A congregate housing facility for the elderly(Montana State University - Bozeman, College of Arts & Architecture, 1983) Architecture 354, Design Studio [class], Montana State University ; professor, Christian Bergum.The focus of this project is a housing facility design for the elderly, who, because of illness, fear of living alone, or inability to take care of themselves, seek protection, in congregate living. Congregate living for the elderly means simply that a group of unrelated elderly people come together to live in the same place considered "home". Home means many things to many people but one requirement most everyone would agree upon is as Webester says, "relaxed and comfortable", you know you belong. It is not so strange to think of such a home as an institution whose primary concern is to provide shelter and, unfortunatly, a very static way of living. Therefore, congregate living encourages an environment where the older person, IS a person, with wants and needs that deserve respect and special attention; to combine social, physical and human activities according to each person; the home should stimulate and relieve bordom through useful activity. A consideration that should be emphasised is that the home make an effort to fit its accommodations to the individual rather than having the individual make adjustments to the rules and regulations of the home.Item An independent living complex for senior citizens, Billings, Montana(Montana State University - Bozeman, 1991) Sowa, Christine M.; Chairperson, Graduate Committee: Peter C. Kommers