Pilot Process Evaluation of the Supporting Older Adults at Risk Model: A RE-AIM Approach

ABSTRACT

Despite evidence supporting transitional care models, hospitals report challenges implementing and sustaining them. The Discharge to Assess (D2A) Model is an innovative solution to this problem but required translation from a national health system context to an U.S.-based context. We translated the central tenets of the D2A model to establish the Supporting Older Adults at Risk (SOAR) Model, which unfolds in three phases: Prepare, Transition, and Support. The purpose of this project was to conduct a process evaluation of the SOAR Model in practice using the RE-AIM Framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Forty patients completed all SOAR Model components for a Reach of 21%. Patients averaged 80 years of age, 53% were female, and 64% Black/AA. SOAR significantly improved discharge before noon, time to first home visit, and use of the in-house pharmacy. SOAR also improved length of hospital stay, emergency department visits, and readmissions. Twenty-one of the 26 Implementation measures unfolded with 75% or greater fidelity. Sixteen of the 24 Adoption measures unfolded with 75% or greater fidelity. COVID-19 limited Maintenance. Given the model unfolds across settings over time, requiring adoption from interprofessional team members, patients, and families, future work should focus on improving reach and adoption.

Trends in observation stays for Medicare beneficiaries with and without Alzheimer's disease and related dementias

BACKGROUND

There has been a marked rise in the use of observation care for Medicare beneficiaries visiting the emergency department (ED) in recent years. Whether trends in observation use differ for people with Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) is unknown.

METHODS

Using a national 20% sample of Medicare beneficiaries ages 68+ from 2012 to 2018, we compared trends in ED visits and observation stays by AD/ADRD status for beneficiaries visiting the ED. We then examined the degree to which trends differed by nursing home (NH) residency status, assigning beneficiaries to four groups: AD/ADRD residing in NH (AD/ADRD+ NH+), AD/ADRD not residing in NH (AD/ADRD+ NH-), no AD/ADRD residing in NH (AD/ADRD- NH+), and no AD/ADRD not residing in NH (AD/ADRD- NH-).

RESULTS

Of 7,489,780 unique beneficiaries, 18.6% had an AD/ADRD diagnosis. Beneficiaries with AD/ADRD had more than double the number of ED visits per 1000 in all years compared to those without AD/ADRD and saw a faster adjusted increase over time (+26.7 vs. +8.2 visits/year; p < 0.001 for interaction). The annual increase in the adjusted proportion of ED visits ending in observation was also greater among people with AD/ADRD (+0.78%/year, 95% CI 0.77-0.80%) compared to those without AD/ADRD (+0.63%/year, 95% CI 0.59-0.66%; p < 0.001 for interaction). Observation utilization was greatest for the AD/ADRD+ NH+ population and lowest for the AD/ADRD- NH- population, but the AD/ADRD+ NH- group saw the greatest increase in observation stays over time (+15.4 stays per 1000 people per year, 95% CI 15.0-15.7).

CONCLUSIONS

Medicare beneficiaries with AD/ADRD have seen a disproportionate increase in observation utilization in recent years, driven by both an increase in ED visits and an increase in the proportion of ED visits ending in observation.

"I'm not a risk taker": Risk Perceptions of Nursing Home Residents With Dementia

BACKGROUND

Persons living with Alzheimer's disease and related dementia (ADRD) in nursing homes (NH) are often excluded from conversations about their health/safety. These omissions impinge on personhood and the rights to have care preferences heard and honored. While persons with ADRD maintain the ability to communicate their preferences long after their decision-making abilities are affected, little is known about how persons with ADRD understand the risks associated with their preferences.

METHODS

As part of a larger focused ethnography, in-depth interviews and an adapted risk propensity questionnaire explored the risk perceptions of NH residents with ADRD (N=7) associated with their preferences for care and activities of daily living.

RESULTS

Residents generally self-identified as risk avoiders (M=3.2±1.84) on the risk propensity scale and were able to rate risk associated with preferences described within 5 thematic categories: 1) participation in decision-making, 2) risk awareness, 3) paying attention to safety, 4) reliance on nursing home staff and family, and 5) impacts on quality of life and quality of care.

DISCUSSION

Results suggest NH residents with ADRD can express risk surrounding their preferences and should be encouraged to participate in discussions about their health and safety.

The association between patient engagement and quality of care interactions among acute care patients with dementia

Effective staff-patient communication is critical in acute care settings, particularly for patients with dementia. Limited work has examined the impact of quality of staff-patient care interactions on patient engagement. The purpose of this study was to determine whether the quality of staff-patient care interactions were associated with active patient engagement during the interaction after controlling for relevant covariates. The study was a secondary data analysis using baseline data from the Function Focused Care for Acute Care intervention study, with a total sample of 286 patients. Descriptive statistics and a generalized linear mixed model were used. The findings indicated that there was a significant relationship between the quality of care interactions and patient engagement such that receiving positive care interactions resulted in higher odds of active patient engagement. These findings can inform future interventions and training for acute care staff to improve quality of care interactions and patient engagement.

Ready or Not: A Conceptual Model of Organizational Readiness for Embedded Pragmatic Dementia Research

The National Institute on Aging Alzheimer's Disease/Alzheimer's Disease and Related Dementias Research Implementation Milestones emphasize the need for implementation research that maximizes up-take and scale-up of evidence-based dementia care practices across settings, diverse populations, and disease trajectories. Organizational readiness for implementation is a salient consideration when planning and conducting embedded pragmatic trials, in which interventions are implemented by provider staff. The current article examines the conceptual and theoretical underpinnings of organizational readiness for implementation and the operationalization of this construct. We offer a preliminary conceptual model for explicating and measuring organizational readiness and describe the unique characteristics and demands of implementing evidence-based interventions targeting persons with dementia and/or their care partners. [Research in Gerontological Nursing, xx(x), xx-xx.].

Factors associated with disagreement between clinician app-based ultra-brief Confusion Assessment Method and reference standard delirium assessments

BACKGROUND

Recently, the Ultra-Brief Confusion Assessment Method (UB-CAM), designed to help physicians and nurses to recognize delirium, showed high, but imperfect, accuracy compared with Research Reference Standard Delirium Assessments (RRSDAs). The aim of this study is to identify factors associated with disagreement between clinicians' app-based UB-CAM assessments and RRSDAs.

METHODS

This is a secondary analysis of a prospective diagnostic test study. The study was conducted at two hospitals and included 527 inpatients (≥70 years old) and 289 clinicians (53 physicians, 236 nurses). Trained research associates performed RRSDAs and determined delirium presence using the CAM. Clinicians administered the UB-CAM using an iPad app. Disagreement factors considered were clinician, patient, and delirium characteristics. We report odds ratios and 95% confidence intervals.

RESULTS

One thousand seven hundred and ninety-five clinician UB-CAM assessments paired with RRSDAs were administered. The prevalence of delirium was 17%. The rate of disagreement between clinician UB-CAM assessments and RRSDAs was 12%. Significant factors associated with disagreement between clinician UB-CAM assessments and RRSDAs (OR [95% CI]) included: presence of dementia (2.7 [1.8-4.1]), patient education high school or less (1.9 [1.3-2.9]), psychomotor retardation (2.5 [1.4-4.2]), and the presence of mild delirium or subsyndromal delirium (5.5 [3.5-8.7]). Significant risk factors for false negatives were patient age less than 80 (2.2 [1.1-4.3]) and mild delirium (3.5 [1.6-7.4]). Significant risk factors for false positives were presence of dementia (4.0 [2.3-7.0]), subsyndromal delirium (5.1 [2.9-9.1]), and patient education high school or less (2.0 [1.2-3.6]). Clinician characteristics were not significantly associated with disagreement.

CONCLUSIONS

The strongest factors associated with disagreement between clinician UB-CAM screens and RRSDAs were the presence of dementia and subsyndromal delirium as risk factors for false positives, and mild delirium and younger age as a risk factor for false negatives. These disagreement factors contrast with previous studies of risk factors for incorrect clinician delirium screening, and better align screening results with patient outcomes.

A Descriptive Study Using Rasch Analysis and Hypothesis Testing to Evaluate the Psychometric Properties of the UMOVE Mobility Screen Tested With Hospitalized Older Adults

The purpose of this study was to test the reliability and validity of the UMOVE Mobility Screen in older adults living with dementia using a Rasch analysis and hypothesis testing. The UMOVE Mobility Screen (UMOVE) focuses on nine activities: following commands, muscle strength, and basic functional mobility tasks. Trained evaluators completed assessments on 244 patients, the majority of whom were female (62%), and White (71%). Based on Rasch Analysis, there was evidence of good item and person reliability (indexes > 0.80), good INFIT statistics, and only one item fitting the model based on OUTFIT statistics. Validity was supported based on hypothesis testing. There was no evidence of Differential Item Functioning between races and genders. Item mapping raised concerns about the spread of the items across the full spectrum of mobility assessed in the UMOVE Mobility Screen. Future testing should consider adding some easier and some more difficult items.

Behavioral and psychological symptoms of dementia and adverse patient outcomes post-hospitalization

OBJECTIVES

The occurrence of behavioral and psychological symptoms of dementia (BPSD) are associated with adverse outcomes but have largely been studied in populations outside of acute care. The current study examines (1) the prevalence of BPSD during acute hospitalization and (2) if BPSD are predictive of adverse patient outcomes.

METHODS

A secondary analysis of Family-centered Function-focused Care (Fam-FFC) data including 461 patients with dementia/care partner dyads assessed at hospital admission, discharge, 2 months, and 6 months post-discharge, was conducted. Prevalence of BPSD (Neuropsychiatric Inventory-Questionnaire total and Frontal, Hyperactivity, Mood, and Psychosis sub-categories), associations with patient and care partner characteristics, and prediction of adverse events (falls, emergency room [ER] visits, hospitalizations, injury) were examined.

RESULTS

BPSD were highly prevalent (93.9% admission, 86.7% discharge). The most common symptom cluster at admission was Hyperactivity (76.7%) followed by Mood (72.3%) and Psychosis (71.9%), and Frontal (25.9%). Higher admission Hyperactivity was associated with ER admissions at 2 months, higher discharge Hyperactivity was associated with ER admissions and hospitalizations at 2 months, and change in Psychosis was associated with ER admissions at 2 months.

CONCLUSIONS

These findings highlight BPSD during hospitalization as potentially modifiable risk factors of adverse outcomes.

Using Hybrid Effectiveness Studies to Facilitate Implementation in Community-Based Settings: Three Case Studies in Dementia Care Research

The pipeline from discovery to testing and then implementing evidence-based innovations in real-world contexts may take 2 decades or more to achieve. Implementation science innovations, such as hybrid studies that combine effectiveness and implementation research questions, may help to bridge the chasm between intervention testing and implementation in dementia care. This paper describes hybrid effectiveness studies and presents 3 examples of dementia care interventions conducted in various community-based settings. Studies that focus on outcomes and implementation processes simultaneously may result in a truncated and more efficient implementation pipeline, thereby providing older persons, their families, health care providers, and communities with the best evidence to improve quality of life and care more rapidly. We offer post-acute and long-term care researchers considerations related to study design, sampling, data collection, and analysis that they can apply to their own dementia and other chronic disease care investigations.

Delirium Severity and Physical Function in Hospitalized Persons Living With Dementia: Moderation by Age, Sex, and Race

OBJECTIVE

This study investigated whether demographic characteristics (age, sex, and race) moderated delirium severity as a predictor of physical function in hospitalized persons living with dementia.

METHODS

The sample consisted of 351 patients enrolled in a randomized controlled trial (Function Focused Care for Acute Care Using the Evidence Integration Triangle). Preliminary analysis was conducted to assess the main effect, and multiple linear regression was used to examine the moderating effect of demographic characteristics between delirium severity and physical function.

RESULTS

Both age and sex were found to have significant moderating effects on the relationship between delirium severity and physical function (β = 2.22; P = 0.02 and β = 1.34; P = 0.04, respectively). Older adults aged 85 years or older with higher levels of delirium severity reported lower levels of physical function compared with older adults aged 65 to 84 years. Males with higher levels of delirium severity reported lower levels of physical function compared with females. Race did not significantly moderate the association between delirium severity and physical function (β = 0.22; P = 0.90).

CONCLUSIONS

Our findings suggest that age and sex may have differential effects on physical function across different levels of delirium severity in hospitalized persons living with dementia.

An exploration of the cultural appropriateness of the family-centered function-focused care intervention

The Family-centered Function Focused Care (Fam-FFC) intervention, is a nurse-family care partnership model aimed to improve the physical and cognitive recovery in hospitalized persons living with Alzheimer's Disease Related Dementias (ADRD) while improving the care partner's experiences. Discussions of patients' needs and preferences between nurses and the patient's close family members have been found to be useful in preventing excessive stress in persons with dementia, while lessening the anxiety of care partners. However, the efficacy of dementia-specific interventions is influenced in part by the degree to which the interventions are flexible and sensitive to the patient's and care-partner's condition, needs, and preferences, including cultural preferences. Therefore, the purpose of this study is to assess the cultural appropriateness of Fam-FFC using the Ecological Validity Model (EVM). This qualitative, descriptive study included 28 consented care partners drawn from a sample of 455 dyads enrolled in the Fam-FFC intervention. An interview guide was created based on the EVM. Participants provided demographic data. Thematic analysis was conducted to analyze transcribed interviews. The majority of the sample was female (79%), Non-Hispanic (96%) and half were married. One-half of the sample represented Black care partners and one-half were White. Seventy-nine percent lived with their family member with ADRD. Three major themes were identified from the thematic analysis including Care Partner Identity, Care Partner Preferences, and Goals of Care for functional recovery of their family member living with dementia. In this study care partners wanted more social services as well as home care that supported not just physical needs but also social and recreational needs. Findings from the study offer guidance on improving the Fam-FFC intervention including strengthening education and resources on partner self-care.

Remodeling Type 2 Diabetes Diagnosis: What Individuals Need for Success

The diagnosis of type 2 diabetes initiates a new health-illness transition. However, little is known about the immediate support that people need to successfully cope with this diagnosis. This qualitative study explored the experiences and immediate support needed at the point of diagnosis among individuals with type 2 diabetes. The findings suggest the need for health care professionals to render immediate emotional support in the form of reassurance and partnership to manage the condition together. Pre- and post-counseling sessions can minimize the emotional and psychological strain associated with the new diagnosis. Individuals should be given information on available resources, as well as an immediate connection with a health care partner who can provide guidance and help with the transition.

Clinical factors associated with the quality of interactions between staff and hospitalized older patients with dementia

This study examines the clinical factors associated with the quality of interactions between staff and hospitalized older patients with dementia. Following examination of bivariate associations, we conducted multiple linear regression in a sample of 140 hospitalized older patients with dementia who participated in the final cohort of an intervention study implementing Family-centered Function-focused Care (Fam-FFC). On average, the participants (male = 46.1%, female = 52.9%) were 81.43 years old (SD = 8.29) and had positive interactions with staff (mean QUIS score = 5.84, SD = 1.36). Accounting for 17.8% of variance in the model, non-pharmacological intervention use (b= 0.170; p<.001) and pain (b= -0.198; p<.01) were significantly associated with the quality of staff-patient interactions. To optimize care of hospitalized patients with dementia, staff should be encouraged to use non-pharmacological interventions. It is also important for staff to assess pain among the patients with dementia and prioritize pain management.

Gender, Pain, and Function Associated With Physical Activity After Hospitalization in Persons Living With Dementia

BACKGROUND

The purpose of this study was to identify factors that are associated with physical activity after hospitalization in persons living with dementia.

METHODS

Multiple linear regressions were conducted to test factors associated with objective activity levels (sedentary, low, moderate, and vigorous) among 244 patients living with dementia from a randomized controlled trial.

RESULTS

Within 48 hours of hospital discharge, time in sedentary behavior was associated with increased pain (β=0.164, P =0.015). Time in low activity was associated with less pain (β=-0.130, P =0.049) and higher physical function (β=0.300, P =<0.001). Time in moderate activity was associated with increased physical function (β=0.190, P =0.008) and male gender (β=0.155, P =0.016). No significant associations of potential factors were found with time in vigorous activity.

CONCLUSIONS

Our findings suggest that managing or reducing pain, encouraging individual functional level, and gender could influence time spent in physical activity after acute hospitalization in persons living with dementia.

Gender differences in interactions and depressive symptoms among hospitalized older patients living with dementia

Alzheimer's disease or a related dementia (ADRD) disproportionately affects women with two-thirds of individuals with ADRD comprised of women. This study examined gender-related differences in the quality of staff-patient interactions and depressive symptoms among hospitalized older patients living with dementia. This secondary analysis utilized baseline data of 140 hospitalized older patients with dementia who participated in the final cohort of a randomized controlled trial (ClinicalTrials.gov identifier: NCT03046121) implementing Family centered Function-focused Care (Fam-FFC). On average, the participants (male = 46.1%, female = 52.9%) were 81.43 years old (SD = 8.29), had positive interactions with staff and lower depressive symptoms based on Quality of Interaction Schedule (QUIS) scores and Cornell Scale for Depression in Dementia (CSDD) scores, respectively. Although males had more positive interactions (male = 6.06, SD = 1.13; female = 5.59, SD = 1.51) and lesser depressive symptoms (male = 7.52, SD = 4.77; female = 8.03, SD = 6.25) than females, no statistically significant gender differences were observed in linear models with appropriate covariates or multivariant analysis of covariant (MANCOVA). However, the multigroup regression conducted to further probe marginally significant moderation effect of gender and pain on staff-patient interactions demonstrated that greater pain was significantly related to lower quality or less positive staff-patient interactions for females compared to males (χ2diff (1) = 4.84, p = .03). Continued evaluation of gender differences is warranted to inform care delivery and interventions to improve care for hospitalized older patients with dementia.

The Association of Cognitive Impairment With Depressive Symptoms, Function, and Pain in Hospitalized Older Patients With Dementia

This study examined the associations between cognition and depressive symptoms, function, and pain among hospitalized older patients with dementia. We utilized baseline data of 461 hospitalized older patients with dementia who participated in an intervention study implementing Family-centered Function-focused Care (Fam-FFC) and conducted stepwise linear regression. On average, the participants (males = 189; 41% and females = 272; 59%) were 81.64 years old (Standard Deviation, SD = 8.38). There was a statistically significant association of cognition with depressive symptoms (b = -0.184, p < .001), functional status (b = 1.324, p < .001), and pain (b = -0.045, p < .001) when controlling for covariates. This study utilized a large sample of a relatively underrepresented population, hospitalized older adults with dementia, and addressed a topic with great clinical significance. Specific focus on testing and implementing best practices or interventions to support the clinical outcomes, and the cognitive function of hospitalized older adults with dementia is warranted in both practice and research.

Caregiver preparedness is associated with desire to seek long-term care admission of hospitalized persons with dementia

INTRODUCTION

Hospitalized patients with dementia are more likely to be discharged to long-term care compared to persons without dementia. Little research has been conducted to examine the associations of caregiver preparedness and strain with desire to seek long-term care in hospitalized persons with dementia at discharge. The purpose of this study was to examine caregiver preparedness and strain as factors associated with desire to seek long-term care admission in caregivers of persons with dementia at hospital discharge.

METHODS

Patient baseline and discharge data, and caregiver discharge data of 424 patient and caregiver dyads from a cluster randomized trial was used. Stepwise multiple linear regression was conducted to examine factors associated with caregiver desire to seek long-term care.

RESULTS

After controlling for caregiver and patient characteristics, lower caregiver preparedness (β = -0.069; p < 0.016) was significantly associated with increased desire to seek long-term care.

DISCUSSION

Findings underscore the need for clinicians and service providers to provide further attention to caregiver preparedness throughout the course of hospitalization.

Testing an Intervention to Improve Posthospital Outcomes in Persons Living With Dementia and Their Family Care Partners

Background and Objectives

Hospitalized persons living with dementia are at risk for functional decline, behavioral symptoms of distress, and delirium, all persisting in the postacute period. In turn, family care partners (FCPs) experience increased anxiety and lack of preparedness for caregiving, compounding existing strain and burden. Family-centered Function-focused Care (Fam-FFC) purposefully engages FCPs in assessment, decision-making, care delivery, and evaluation of function-focused care during and after hospitalization (within 48 hours of discharge, weekly telephone calls for a total of 7 additional weeks, then monthly for 4 months). The objective of this study was to test the efficacy of Fam-FFC.

Research Design and Methods

A cluster randomized controlled trial included 455 dyads of persons living with dementia and FCPs in 6 medical units in 3 hospitals. Patient outcomes included return to baseline physical function, behavioral symptoms of distress, depressive symptoms, and delirium severity. Family care partner measures included preparedness for caregiving, anxiety, strain, and burden.

Results

Multilevel level modeling demonstrated that the likelihood of returning to baseline function across time for Fam-FFC participants was twice that of the control group by the end of 6 months (OR = 2.4, p = .01, 95% CI 1.2-4.7). Family-centered Function-focused Care was also associated with fewer symptoms of distress (b = -1.1, SE = 0.56, p = .05) but no differences in the amount of moderate physical activity, depressive symptoms, and delirium severity. Preparedness for caregiving increased significantly only from 2 to 6 months (b = 0.89, SE = 0.45, d = 0.21, overall p = .02) in the intervention group, with no group differences in anxiety, strain, and burden.

Discussion and Implications

Family-centered Function-focused Care may help prevent some of the postacute functional decline and behavioral symptoms in hospitalized persons living with dementia. Further research is needed to promote sustained improvements in these symptoms with more attention to the postacute needs of the care partner.

Differences in Medication Use by Gender and Race in Hospitalized Persons Living with Dementia

The purpose of this study was to describe differences in treatment of White versus Black older adults, males versus females, and those living at home, assisted living, or nursing home communities with regard to the use of psychotropic, pain, and cardiovascular medications. Baseline data from the first 352 participants in the study, implementation of Function-Focused Care for Acute Care Using the Evidence Integration Triangle, were used. Data included age, gender, race, comorbidities, admission diagnosis, and living location prior to hospitalization, the Saint Louis University Mental Status exam, the modified Charlson Comorbidity Index, the Pain Assessment in Advanced Dementia scale, the Confusion Assessment Method, and medications prescribed. Generalized linear mixed model analyses were done, controlling for race or gender (depending on which comparison analysis was being done), age, cognitive status, hospital, delirium, and comorbidities. Medication use was significantly higher for White older adults, compared to Black older adults, for antidepressants, anxiolytics, non-opioid pain medications, and opioids and lower for antihypertensives. Females received more anxiolytics than their male counterparts. There were differences in medication use by living location with regard to non-opioid pain medication, antipsychotics, statins, and anticoagulants. The findings provide some current information about differences in medication use across groups of individuals and can help guide future research and hypothesis testing for approaches to minimizing these differences in treatment.

Factors Associated With Physical Activity in Hospitalized Patients With Dementia

Older adults continue to spend little time engaged in physical activity when hospitalized. The purpose of this study was to (a) describe activity among hospitalized older adults with dementia and (b) identify the association between specific factors (gender, ambulation independence, comorbidities, race, and hospital setting) and their physical activity. This descriptive study utilized baseline data on the first 79 participants from the Function Focused Care for Acute Care using the Evidence Integration Triangle. Multiple linear regression models were run using accelerometry data from the first full day of hospitalization. The participants spent an average of 83.7% of their time being sedentary. Male gender, ambulation independence, and hospital setting (the hospital in which the patient was admitted) were associated with greater activity. This study reports on the limited time spent in activity for older adults with dementia when hospitalized and highlights patient profiles that are particularly vulnerable to sedentary behavior in the hospital setting.

Cognitive Exercise for Persons with Alzheimer's Disease and Related Dementia Using a Social Robot

Reminiscence therapy (RT) can improve the mood and communication of persons living with Alzheimer's Disease and Alzheimer's Disease related dementias (PLWD). Traditional RT requires professionals' facilitation, limiting its accessibility to PLWD. Social robotics has the potential to facilitate RT, enabling accessible, home-based RT. However, studies are needed to investigate how PLWD would perceive a robot-mediated RT (RMRT) and how to develop RMRT for positive user experience and successful adoption. In this paper, we developed a prototype of RMRT using a humanoid social robot and tested it with 12 participants (7 PLWD, 2 with mild cognitive impairment, and 3 informal caregivers). The robot automatically displayed a memory trigger on its tablet and engaged participants in a relatable conversation during RMRT. A mixed-method approach was employed to assess its acceptability and usability. Our results showed that PLWD had an overall positive user experience with the RMRT. Participants laughed and sang along with the robot during RMRT and demonstrated intention to use it. We additionally discussed robot control method and several critical problems for RMRT. The RMRT can facilitate both verbal and nonverbal social interaction for PLWD and holds promise for engaging, personalized, and efficient home-based cognitive exercises for PLWD.

Factors Associated With Function-Focused Care Among Hospitalized Older Adults Living With Dementia

This article reports a study that was designed to describe the incidence of pain among older hospitalized patients with dementia and to evaluate the factors that influence pain among these individuals. It was hypothesized that function, behavioral and psychological symptoms of dementia, delirium, pain treatment, and patient exposure to care interventions would be associated with pain. Patients who performed more functional activities had less delirium. They also experienced higher quality-of-care interactions and were less likely to have pain. The findings from this study support the relationship between function, delirium, and quality-of-care interactions and pain. It suggests that it may be useful to encourage patients with dementia to engage in functional and physical activity to prevent or manage pain. This study serves as a reminder to avoid neutral or negative care interactions among patients with dementia as a strategy to mediate delirium and pain.

Factors Associated With Function-Focused Care Among Hospitalized Older Adults With Dementia

BACKGROUND

Function-focused care is an approach used to increase physical activity in hospitalized older adults with dementia.

OBJECTIVE

To explore factors associated with participation in function-focused care in this patient population.

METHODS

This was a cross-sectional descriptive study using baseline data from the first 294 participants in an ongoing study on testing function-focused care for acute care using the evidence integration triangle. Structural equation modeling was used for model testing.

RESULTS

The mean (SD) age of the study participants was 83.2 (8.0) years, and the majority were women (64%) and White (69%). Sixteen of the 29 hypothesized paths were significant and explained 25% of the variance in participation in function-focused care. Cognition, quality of care interactions, behavioral and psychological symptoms associated with dementia, physical resilience, comorbidities, tethers, and pain were all indirectly associated with function-focused care through function and/or pain. Tethers, function, and quality of care interactions were all directly associated with function-focused care. The χ2/df was 47.7/7, the normed fit index was 0.88, and the root mean square error of approximation was 0.14.

CONCLUSION

For hospitalized patients with dementia, the focus of care should be on treating pain and behavioral symptoms, reducing the use of tethers, and improving the quality of care interactions in order to optimize physical resilience, function, and participation in function-focused care.

Treatment Fidelity of the Family-Centered Function-Focused Care Intervention

The purpose of the current study was to evaluate treatment fidelity (i.e., the extent to which an intervention is provided as intended) in the Family-Centered Function-Focused Care (Fam-FFC) intervention. This was a descriptive study using data collected during intervention activities throughout the course of the Fam-FFC study. Specific measures included Environment and Policy Assessments, Fam-FFC Knowledge Test, Goal Attainment Scale, Function-Focused Care Behavior Checklist, and completion of the FamPath Audit. Delivery was provided as intended. Staff demonstrated intervention skills with only one Fam-FFC research nurse needing retraining. Receipt was based on Fam-FFC Knowledge Test scores >80%, with the majority of participants reporting goal achievement as expected or higher than expected and slight improvement in environments and policies to better support Fam-FFC. Lastly, enactment was based on evidence that in 67% of observations staff provided at least one function-focused care intervention. Findings from this study will be used to adapt the intervention to reach all staff, increase ways to change environments and policies, consider ways to more comprehensively evaluate enactment of function-focused care during real-world interactions, and consider the characteristics of nursing staff and whether a relationship exists between staff characteristics and providing function-focused care. [Research in Gerontological Nursing, 16(4), 165-171.].

The Modified Caregiver Strain Index in Black and White Dementia Caregivers at Hospital Discharge

OBJECTIVES

This study aimed to examine psychometric properties of the Modified Caregiver Strain Index (MCSI) in Black and White caregivers of persons living with dementia at hospital discharge.

METHODS

This was a cross-sectional study using baseline data of 423 family caregivers recruited from a cluster randomized clinical control trial. Factor structure, measurement invariance, and concurrent validity of the MCSI were analyzed. The moderating role of race on the relationship between MCSI score and anxiety, depression, and burden was also examined.

RESULTS

The two-factor model fits the data best and was invariant across race. Regarding concurrent validity, higher MCSI scores were significantly associated with higher scores on the (HADS-A; anxiety), (HADS-D; depression), and (ZBI; burden). Race moderated the relationship between MCSI score and anxiety, depression, and burden.

CONCLUSIONS

The MCSI is a valid tool to assess caregiver strain in Black and White caregivers of persons living with dementia during hospital discharge. Results suggest that the effect of MCSI score on anxiety, depression, and burden varies by race.

CLINICAL IMPLICATIONS

MCSI can be used by clinicians and service providers to help support the needs of Black and White caregivers of people living with dementia during post-hospital transition.

Psychotropic Medication Use and Changes During Hospitalization for Older Adults Living With Dementia

To describe the use of psychotropic medications among older hospitalized patients. This was a descriptive study using baseline data from the first 308 older patients in a function focused care intervention study. Age, gender, race, comorbidities, admitting diagnosis, and medications (antidepressants, antianxiety medications, anticonvulsants, dementia drugs, antipsychotics, sedative-hypnotics, and opioids) were obtained at baseline and discharge. To compare change over time, generalized estimating equations were used. Participants were mostly female (63%) and White (69%) and were 83.1 years old on average. Antidepressant, antianxiety, anticonvulsant, dementia medication, sedative-hypnotic, and opioid use remained essentially unchanged between admission and discharge. Antipsychotic medication use increased significantly from 16% to 21% at discharge. There was persistent use of psychotropic medication among hospitalized older adults living with dementia and little evidence of deprescribing. There was some indication of changes made during hospitalization that may be appropriate, even without a focused deprescribing initiative.

Psychometrics of the Physical Resilience Scale in Older Adults Living with Dementia: Proxy Responses

Objectives: The purpose of this study was to determine if proxies can complete the Physical Resilience Scale for older adults living with dementia. Methods: This was a descriptive study using Rasch analysis and baseline data from the Function Focused Care for Acute Care Using the Evidence Integration Triangle trial. The first 240 patients living with dementia were included in this analysis. Results: There was evidence of reliability based on person and item separation index. There was no evidence of Differential Item Functioning (DIF) between genders and a DIF by race on Item 7. Validity was supported based on items fitting the model with the exception of one item, and a significant relationship between physical resilience and pain and function. Discussion: There is some evidence that the Physical Resilience Scale is reliable and valid when completed by proxy reports. Future use should remove one of the items due to redundancy.

Physical Activity Level and Specific Type of Exercises Among US Middle-Aged and Older Adults: Findings From the Behavioral Risk Factor Surveillance Survey

BACKGROUND

This study aimed to assess physical activity level and identify specific types of exercises by sex, race/ethnicity, and age for adults 50 years and older.

METHODS

Behavioral Risk Factor Surveillance System 2013, 2015, and 2017 data were used to study US adults 50 years and older on their specific types of exercises, stratified by sex, race/ethnicity, and age. Weighted logistic regression was used to model physical exercise level and specific types of exercises.

RESULTS

The sample included 460,780 respondents. Non-Hispanic Black and Hispanic were less likely than non-Hispanic White to meet the recommended physical activity level (Odds ratio [OR] = 0.73, P < .0001 and OR = 0.96, P = .04, respectively). Walking was the most participated type of exercise, followed by gardening, for both men and women, all racial/ethnic groups, and all age groups. Non-Hispanic Blacks were more likely to participate in walking (OR = 1.19, P = .02) and less likely to participate in gardening (OR = 0.65, P < .0001) than non-Hispanic Whites. Men were more likely to engage in strenuous exercises than women. The average number of minutes on walking was the longest among all types of specific exercises.

CONCLUSIONS

The types of exercises were mostly walking and gardening for adults aged 50 and older. Non-Hispanic Black adults had less physical activity than non-Hispanic White and were less likely to engage in gardening.

Delirium and Behavioral Symptoms in Persons With Dementia at Hospital Admission: Mediating Factors

BACKGROUND

Hospitalized persons with dementia are at risk of delirium with behavioral symptoms, predisposing them to a higher rate of complications and caregiver distress. The purpose of this study was to examine the relationship between delirium severity in patients with dementia upon admission to the hospital and the manifestation of behavioral symptoms, and to evaluate the mediating effects of cognitive and physical function, pain, medications, and restraints.

METHODS

This descriptive study used baseline data from 455 older adults with dementia enrolled in a cluster randomized clinical trial that tested the efficacy of family centered function-focused care. Mediation analyses were conducted to determine the indirect effect of cognitive and physical function, pain, medications (antipsychotics, anxiolytics, sedative/hypnotics, narcotics, and number of medications), and restraints on behavioral symptoms, controlling for age, sex, race, and educational level.

RESULTS

The majority of the 455 participants were female (59.1%), had an average age of 81.5 (SD=8.4), were either white (63.7%) or black (36.3%), and demonstrated one or more behavioral symptoms (93%) and delirium (60%). Hypotheses were partially supported in that physical function, cognitive function, and antipsychotic medication partially mediated the relationship between delirium severity and behavioral symptoms.

CONCLUSION

This study provides preliminary evidence identifying antipsychotic use, low physical function, and significant cognitive impairment as specific targets for clinical intervention and quality improvement in patients with delirium superimposed on dementia at hospital admission.

Pathway From Type 2 Diabetes Diagnosis to Action: How to Move People Forward

Seven self-care behaviors-healthy coping, healthy eating, being active, taking medication, monitoring, reducing risk, and problem-solving-are recommended for individuals with diabetes to achieve optimal health and quality of life. People newly diagnosed with type 2 diabetes may find it challenging to learn and properly incorporate all of these self-care behaviors into their life. This qualitative study explored the experiences and perceived immediate self-management and psychosocial support needs in individuals newly diagnosed with type 2 diabetes. Data analysis revealed the significant challenges individuals encounter after a type 2 diabetes diagnosis. Five main themes were identified: 1) type 2 diabetes diagnosis competes with other complex life challenges, 2) difficulty in performing behavior modification actions, 3) lack of support, 4) emergence of emotional and psychological issues, and 5) need for planned individualized follow-up support after a type 2 diabetes diagnosis. This study revealed a gap in care after type 2 diabetes diagnosis. Individualized support is needed to assist people in moving successfully from diagnosis to being well equipped with the knowledge and skills necessary to properly manage the condition.

Optimal Approach for Assessing Evidence of Dementia for Research Studies

The purpose of this study was to describe a process to determine the presence of dementia and test the psychometric properties of the proposed measurement model for dementia. The model included the AD8, the Functional Activities Questionnaire, the Clinical Dementia Rating Scale, and the Saint Louis University Mental Status Examination. A total of 346 patients consented and 176 of those were determined to be eligible as a result of screening with this measurement model. The mean age of the participants was 80.70 (SD = 9.60) and the majority were female (64%), white (66%), not Latinx (99%), and not married (67%). There was evidence of reliability based on the internal consistency of the items on all measures and the limited error associated with each item. There was evidence of construct validity based on model fit. All four measures are recommended as a pragmatic way in which to comprehensively determine evidence of dementia for research studies.

Caregiving for Persons Living With Dementia During the COVID-19 Pandemic: Perspectives of Family Care Partners

Persons living with dementia (PLWD) are at increased risk for coronavirus disease 2019 (COVID-19) and poorer outcomes if they contract the disease. COVID-19 may also change and exacerbate usual stresses of family caregiving. The current qualitative descriptive study examined 14 family care partners' (FCPs) experiences and perspectives on how the COVID-19 pandemic impacted them, their care recipients, and their caregiving for their care recipients. Thematic analysis of interviews generated five themes: Cautious of COVID-19 Exposure, Challenges of Balancing COVID-19 Restrictions With Caregiving, Shared Loneliness, Functional Decline, and Communication Challenges With PLWD and Health Care Professionals (HCPs). FCPs are integral to the care of PLWD across care settings. The time is now to plan for changes in policy that will safely maintain FCPs' visitation with their care recipients with dementia and allow for partnering with HCPs to avoid the long-lasting negative effects on older adults' health and function. [Journal of Gerontological Nursing, 49(3), 27-33.].

The association of physical activity and behavioral and psychological symptoms among a sample of hospitalized older adults living with dementia

OBJECTIVES

The aims of this study were to: (1) describe the prevalence of behavioral and psychological symptoms of dementia in hospitalized older adults living with dementia and (2) examine the association of physical activity and behavioral and psychological symptoms of dementia among hospitalized older adults living with dementia, after controlling for covariates.

METHODS

Physical activity was measured using the Physical Activity Survey and behavioral and psychological symptoms of dementia were measured using the Neuropsychiatric Inventory. Descriptive analysis and multiple linear regressions were run using baseline data on 294 older adults with dementia hospitalized on general medical units from an ongoing study entitled Function Focused Care for Acute Care Using the Evidence Integration Triangle.

RESULTS

Participants performed an average of 7.92 (SD = 4.49) of 34 possible activities "in the last 24 h" prior to the Physical Activity Survey administration. A total of 132 participants (45.5%) had at least one behavioral and psychological symptom of dementia. We found that physical activity was not associated with behavioral and psychological symptoms of dementia (b = 0.01; p = 0.56), after controlling for covariates.

CONCLUSIONS

Although this study found no evidence of an association between physical activity and behavioral and psychological symptoms of dementia, evidence of physical activity did not exacerbate these behaviors. Thus, given the benefits of physical activity, it is important to continue to encourage patients living with dementia to engage in activity.

A Systematic Review of Barriers and Facilitators of Pain Management in Persons with Dementia

Approximately 50% of persons living with dementia experience pain, yet it is frequently undetected and inadequately managed resulting in adverse consequences. This review aims to synthesize evidence on the barriers and facilitators of pain management in persons living with dementia. PubMed, CINAHL, PsycINFO, and Web of Science datasets were used for article searching. Inclusion criteria were peer-reviewed original articles written in English that examined the barriers and facilitators of pain management for persons living with dementia. The Mixed Methods Appraisal Tool was used to evaluate the quality of the studies. A total of 26 studies were selected, including 18 qualitative and 3 quantitative (all high quality), as well as 5 mixed methods studies (low-to-high quality). Results were categorized into intrapersonal, interpersonal, environmental, and policy categories. Factors that impact pain management in dementia include cognitive and functional impairment, healthcare workers' knowledge, collaboration and communication, healthcare workers' understanding of patients' baseline behaviors, observation of behaviors, pain assessment tool use, pain management consistency, staffing level, pain guideline/policy, and training. Overall, pain management is challenging in persons living with dementia. The results indicate that there is a need for multi-component interventions that involves multidisciplinary teams to improve pain management in persons living with dementia at the intrapersonal, interpersonal, environmental, and policy levels. PERSPECTIVES: This review systematically synthesized barriers and facilitators of providing pain management in persons living with dementia. Results were presented in intrapersonal, interpersonal, environmental, and policy categories and suggests that multicomponent interventions involving multidisciplinary teams are needed to systematically improve pain management in persons living with dementia.

Use of a Humanoid Robot in Supporting Dementia Care: A Qualitative Analysis

Introduction

Cognitive impairment significantly affects independence in persons with dementia, and consistent supervision is often needed. While interest has arisen in using humanoid robots, such as Pepper, to assist with daily caregiving activities, little is known about the perceptions of using Pepper to assist people with dementia.

Objective

This study aimed to explore the perceptions of nonhealthcare workers, care partners, and healthcare workers on the use of a Pepper robot in dementia care.

Methods

This was a secondary qualitative analysis. Data were collected from a pilot study conducted from November 2020 to March 2021 using an online survey. The survey consisted of quantitative and qualitative questions; this study only focused on the qualitative responses. The detailed procedures and the quantitative results were published elsewhere. Participants included nonhealthcare workers, care partners, and healthcare workers.

Results

A total of 194 participants responded to the open-ended question. Participants described potential benefits of Pepper including assisting with daily activities, monitoring safety and medication use, initiating reminders, and promoting activities and social interactions. Participants had concerns about privacy, cost, poor acceptance/trust, Pepper making mistakes, limitations in environmental navigation and responding to emergencies, misuse of Pepper, and Pepper replacing humans. Participants suggested that Pepper should be tailored to each individual's background, preferences, and functions and recommended improving the logistics of using Pepper, offering more emotional support and responses, and using a more natural appearance and voice.

Conclusion

Pepper may support dementia care; yet some concerns need to be addressed. Future research should consider incorporating these comments when designing robots for dementia care.

Reducing Behavioral and Psychological Symptoms of Dementia in Acutely Ill Patients via Patient Engagement Specialists: A Pilot Feasibility Study

Behavioral and psychological symptoms of dementia (BPSD) are common in hospitalized persons living with dementia (PLWD). This pilot aimed to test the feasibility of an innovative model of care, PES-4-BPSD (a dementia unit staffed with Patient Engagement Specialists, PES). Non-randomized pilot feasibility trial was conducted, enrolling N = 158 patients to the intervention unit (n = 79, a 10-bed dementia unit, staffed with nursing assistants, NAs, with mental health backgrounds, PES) and an enhanced control unit (n = 79, 40-bed medicine unit, staffed with NAs). All NAs/PES (N = 63) received dementia training, with completion rate of 82.5%. Overall, patients had ~1 NPI-Q (Neuropsychiatric Inventory Questionnaire) assessment/48 hr. 97% (n = 153) of PLWD exhibited at least one behavior. Average NPI-Q scores did not differ across intervention (5.36) and control (3.87) units (p = .23). Patients on the intervention unit had 88% (p = .002) shorter duration of constant observation. A dementia care unit staffed by PES is an innovative model requiring further research.

REVISITING THE TEACHING NURSING HOME: IMPACT ON NURSING STUDENTS’ PERCEPTIONS OF WORKING IN LONG-TERM CARE

Revisiting the Teaching Nursing Home is a two-year pilot project to address the long-term care workforce shortage by introducing nursing students to geriatric nursing while improving quality of care within nursing homes. The initiative has multiple components: enhanced clinical rotations for nursing students with partner schools of nursing, implementation of the Institute for Healthcare Improvement Age-Friendly Health System “4M” quality improvement model, and an online learning network. Nursing students at three schools of nursing participated in the clinical rotations at regional nursing homes. The experience was limited to students in one specific course at each school of nursing. At the beginning and end of the spring 2022 semester, students rated their competence in: patient assessment, collaborating with the care team, gathering clinical information, medication review, eliciting resident values, and health promotion. Students also rated their preferences for working in long-term care and with older adults. Data from 85 responses at the start of semester and 64 responses to the end of semester survey were analyzed. Analysis of student responses found that students self-rated competencies improved in all areas except eliciting resident values. Prior to their clinical experience, students ranked working in long-term care and with older adults lower than other settings or populations. The rankings were unchanged after their clinical experiences. These initial findings suggest that although the Teaching Nursing Home Program is meeting the pedagogical goals, attitudinal shifts may require different strategies.

“I'M NOT A RISK-TAKER”: RISK PERCEPTIONS OF NURSING HOME RESIDENTS WITH DEMENTIA

Persons living with dementia (PLWD) in nursing homes (NH) are often left out of care conversations about their health and safety. These omissions impinge on their personhood and rights to have care preferences heard and honored. PLWD maintain the ability to communicate values and preferences long after their decision-making abilities are affected by cognitive changes. This study explored risk perceptions of PLWD associated with their care preferences. As part of a larger focused ethnography conducted during the COVID-19 pandemic, in-depth interviews explored risk perceptions of residents (N=7) with dementia (BIMS M=9.29). Using a risk propensity survey, residents self-identified as risk avoiders (M=3.2) and content analysis of interviews revealed that PLWD perceive physical and psychosocial harms (e.g., high blood sugar, falls, choking) and benefits (e.g., feeling good, social interactions, reminiscing) related to care preferences. Results suggest it is possible for PLWD with varying levels of cognitive decline to participate in discussions about their health and safety.

ASSESSING PREFERENCES FOR COMMUNICATING WITH TECHNOLOGY: A PERSON-CENTERED APPROACH TO CARE MANAGEMENT

Technological advances, such as telehealth, have been used to manage the multiple chronic conditions that impact over 25% of the US adult population. Technology-assisted communication (TAC) can help to bridge the gap in effective management of health conditions in the community by patients, informal caregivers, and healthcare providers, while emphasizing person-centered care. The purpose of this project was to develop a new theoretically-derived and evidence based subscale for the Preferences for Everyday Living Inventory (PELI) that addresses preferred TAC approaches for community-dwelling adults over the age of 50 years in the context of multiple chronic conditions (N=297). Results indicated that over 60% of older adults are satisfied with technology-based healthcare communications. In general, older adults in the sample are satisfied with all domains of technology-assisted communication that are asked within P-TAC, including timing, sending and receiving of information, and content of communications. Almost 80% (N=234) indicate that they are satisfied with the content of TAC. This research has lead to the development of assessment items that will allow providers to better assess and then integrate patient preferences for technology communication strategies into plans of care. Potential benefits of understanding preferences for TAC include alignment of chronic care management with preferred strategies which may lead to improvement care congruence and improved healthcare outcomes for the older adult.

VERBAL COMMUNICATION BETWEEN NURSING HOME STAFF AND RESIDENTS WITH DEMENTIA AND APATHY: LANGUAGE ANALYSIS

Communication is fundamental in daily caregiving activities in nursing homes and impacts the quality of care. This study examined the verbal communication of nursing home staff and residents with dementia and apathy during daily caregiving activities. This study used a repeated measures design. Participants included 13 residents with dementia and apathy and 13 staff from two nursing homes. A total of 39 videos were recorded to capture staff-resident interactions during caregiving activities (3 videos for each resident). All video-recorded communication was transcribed and segmented into phrases. Bivariate correlations were used for preliminary analysis. The average length of each interaction was 7.5 minutes (range=1.5-12.5). On average, staff verbalized 46.6 words (range=9.3-121.9) with 11.3 phrases (range=3.7-23.4) per minute. Residents verbalized an average of 18.9 words (range=0-83.8) with 4.8 phrases (range=0-17.1) per minute. Unadjusted correlations demonstrated that residents’ phrases per minute were significantly negatively associated with apathy (r=-0.36, p =0.0239), while being significantly positively associated with age (r=0.42, p=0.0071), cognitive function (r=0.42, p=0.0114), caregivers’ words per minute (r=0.44, p=0.0055), and phrases per minute (r=0.42, p=0.0077). After adjusting for clustering by residents, caregivers’ words and phrases remained significantly positively associated with residents’ phrases. Findings suggest that higher resident apathy and cognitive impairment are associated with fewer verbalizations. When caregivers verbalize more phrases and words, residents are also likely to use more phrases. Findings identify the high-risk population for lack of verbal expression and emphasize the importance of staff verbal communication to promote verbal communication in nursing home residents with dementia and apathy.

FAMILY PREPAREDNESS AT HOSPITAL DISCHARGE OF THE PERSON LIVING WITH DEMENTIA

Family care partners face increased and more complex caregiving demands at the time of hospital discharge for persons living with dementia. This study examined family care partners’ needs for preparation and factors associated with the degree of preparation for caregiving. Care partners who were younger (t=3.26, p=.001), demonstrated anxiety (t= 2.6, p=.010) and depression (t =4.6, p <.001), and were caring for a person in pain (t=2.3, p=.023) had lower scores on the Preparation for Caregiving Scale. Care partners described the least preparation to care for the patients’ emotional needs (M= 2.8, SD=1.2) and deal with the stress of caregiving (M= 2.7, SD=1.2). Content analysis of nurses’ transitional care notes converged with these findings, while also describing a lack of preparation to advocate for information from medical providers. Findings suggest the need to attend to the psychological and informational needs of care partners, while considering patient well-being and comfort.

GENDER DIFFERENCES IN INTERACTIONS AND WELL-BEING AMONG HOSPITALIZED PATIENTS LIVING WITH DEMENTIA

While the incidence of dementia is generally higher in women compared to men, gender differences in interactions and well-being in dementia is still unclear. This study examined gender differences in interactions and well-being among hospitalized patients living with dementia. A total of 140 hospitalized patients (53% female and 47% male) were included in the analysis. On average, the participants were 81.43 years old (SD= 8.29), had positive interactions with staff based on higher scores on Quality of Interaction Schedule, QUIS (5.81, SD= 1.36), and fair emotional well-being based on lower scores on Cornell Scale for Depression in Dementia, CSDD (7.79, SD= 5.59). Although men seemed to have more positive interactions (male=6.07, SD=1.13; female=5.59, SD=1.51) and greater wellbeing (male=7.52, SD=4.77; female=8.03, SD=6.25) than women, there were no statistically significant gender differences observed in linear models with appropriate covariates. Future work should continue to explore gender differences in interactions and well-being.

A CONCEPTUAL MODEL OF ORGANIZATIONAL READINESS FOR IMPLEMENTATION OF EMBEDDED PRAGMATIC DEMENTIA RESEARCH

Organizational readiness for implementation refers to the collective willingness and efficacy of people, processes, and internal and external contexts within study sites to implement an intervention; it is a salient consideration when planning and conducting embedded pragmatic trials. This paper examines the conceptual and theoretical underpinnings of organizational readiness for implementation and the operationalization of the construct. We synthesize the literature to offer a conceptual model for explicating and measuring organizational readiness for implementation and describe the unique characteristics and demands of implementing evidence-based interventions targeting persons with dementia and/or their care partners. Our model was derived from the Consolidated Framework for Implementation Research (CFIR), and Weiner’s Determinants and Outcomes of Organizational Readiness for Change. We discuss how it can serve as a guide when planning and conducting embedded pragmatic implementation trials in settings that care for persons with dementia.

IMPLEMENTING FUNCTION-FOCUSED CARE IN THE HOSPITAL: LESSONS LEARNED

The mentorship provided by the nurse interventionist is an important implementation strategy to support Function-focused care adoption in hospitalized older adults with dementia. The nurse interventionist works with unit champions and interdisciplinary stakeholder teams over a 12 month period. The first interaction includes using a brainstorming approach to develop unit-specific goals to support the integration of function-focused care into routine care delivery. Implementation strategies at the unit level include flexible staff training, involving staff in evaluations of care interactions, targeting pragmatic measures, and a feedback loop. Based on content analysis of field notes we will describe stakeholder goals established, action plans, and barriers and facilitators to meet goals in four hospital units. Key findings include the influence of leadership support, communication strategies, engagement of direct care staff, interdisciplinary collaboration, access to human and material resources, and contextual factors within the hospital setting (including pandemic-related challenges).

COMMUNICATION WITH HEALTHCARE PROVIDERS DURING THE PANDEMIC: EXPERIENCES OF OLDER ADULTS

The COVID-19 pandemic introduced many societal changes, including the need to use technology to communicate with healthcare providers. For many this was a new form of communication. This study examines (1) who older adults identified as healthcare providers and (2) reflected on how communications with formal healthcare providers changed during the pandemic. This data is a subset of a cross-sectional descriptive survey that was distributed electronically to a sample of community-dwelling older adults aged 65 years and older (N=323). Qualitative data was analyzed using thematic analysis. Quantitative data was analyzed using descriptive statistics. Participants averaged 72.7 years of age and 74.5% were retired. Just over ¼ of the sample identified nurses as part of their formal healthcare team; however, participants who identified nurses as formal healthcare providers had fewer negative themes regarding telehealth communication with healthcare providers compared to those who did not. They were also more likely to support in-person and technology driven communication models in the future. Telehealth remains an evolving form of primary healthcare that was utilized throughout the COVID-19 pandemic. Many older adults in our study considered it a resource that requires further optimization while others were staunch opponents to its continued employment in healthcare settings. Nurses are a vital part of our healthcare system and frequently interact with patients and families to coordinate care. Further research should examine how different scopes of nursing practice can support the implementation of telehealth to improve care delivery among community-dwelling older adults.