Education in end-of-life care: bridging disciplinary and institutional boundaries.

This paper describes the development of an interdisciplinary, interinstitutional seminar in palliative care for South Dakota students in medicine, nursing, pharmacy, chaplaincy, and social work. Student outcomes from six seminars conducted during 2001-2004 are reported, and recommendations for future educational efforts are outlined.

The Medication Reduction Project: combating polypharmacy in South Dakota elders through community-based interventions.

The Medication Reduction Project (MED RED) is a community-based program addressing polypharmacy issues in elders. Using educational presentations and one-on-one medication reviews conducted by a pharmacist specializing in geriatrics, MED RED reached over 1,100 older adults in rural and urban southeastern South Dakota communities during 1993. Analysis of the longitudinal data indicate that older adults participating in one-on-one reviews were on fewer medications, had dosage reductions, were more likely to take their medications as directed, and increased their use of non-pharmacological alternatives. These elders also reported feeling better, spent less money per month on medications, and offered indications of improved functioning and increased levels of independence. These findings suggest that education about medication use is a dynamic tool in empowering community-based older adults to be assertive participants in their own health care.

MealMate: improving the nutritional status of elders using a milk-based nutritional supplement.

MealMate was a longitudinal research project conducted by the staff at the Geriatric Health Institute, a joint venture between Sioux Valley Hospital and the University of South Dakota School of Medicine. During Fall 1994, 64 older adults enrolled in this nutrition study at a Sioux Falls congregate dining site and drank a half-pint of whole milk combined with Carnation Instant Breakfast daily for one month. Pre-test and post-test data collected included anthropometric measures, specific blood tests from a venipuncture blood draw and use of standardized instruments to assess nutritional risk, depression, mental status and general demographic information. Results suggest that a longitudinal study with elders can be done effectively (attrition rate of less than 11%). While elders were very healthy at the onset, they nevertheless showed improved nutritional status over time. Laboratory tests showed significant increases in Vitamin D levels in adults over age 79. Using a more malnourished, home-bound sample of elders over age 79 and adding only whole milk to their diets are discussed as possible considerations for future research.

Daily self-reports on activities, life events, moods, and somatic changes during the menstrual cycle.

Thirty-three undergraduate students (11 males, 11 females taking oral contraceptives, and 11 females not taking oral contraceptives) filled out daily self-reports on pleasant activities, stressful events, moods, and somatic changes for 35 consecutive days. By randomly assigning each male a "pseudo" cycle, the data were analyzed to compare the three samples across the three phases of the menstrual cycle. The results indicated that males reported somewhat more stable but less positive experiences than females. While males reported a stable, low level of pain and water retention throughout the study, both female samples reported increases during the premenstrual and menstrual phases. Reports of negative affect, impaired concentration, and stressful events did not differ by samples, but significant sample by cycle interactions reflected differential increases in the two female samples during the premenstrual and menstrual phases. Subsequent analyses indicated that the experience of stressful events accounted for more of the variance than did cycle phase for these negative mood factors, but not for pain and water retention.