scholarly journals Opportunities to Impact Disability: Trends, Costs, and Evidence-Based Interventions

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 117-118
Author(s):  
Sarah Szanton ◽  
David Grabowski
Keyword(s):  
Older Adults ◽  
Community Dwelling ◽  
Health Care Use ◽  
Published Data ◽  
Emergency Department Use ◽  
Demographic Groups ◽  
Functional Capabilities ◽  
Home Based ◽  
Individual Capacity ◽  
Medicare Costs

Abstract As healthcare shifts to a focus on social determinants and population health, and older adults increasingly seek to “age in community,” it is vital to understand the functional capabilities and related costs for older adults with disability. This symposium will present data on five major areas related to older adult disability. The 1st presenter will describe recent national disability trends. The 2nd will present Medicare costs by disability, dementia, and community-dwelling status in order to illustrate how these different demographic groups vary in Medicare expenditures over time. This information is critical to policymakers and health systems leaders to plan for these populations. They will then describe a 3rd project, which employs a novel longitudinal modeling approach, Group Based Trajectory Modeling, to identify and describe the distinct trajectories of Emergency Department use after incident disability. This work assesses the heterogeneity in health care use after disability, which may be shaped by available supports. The 4th presentation will describe a combined analysis of the 11 sites that have published data from implementations of the CAPABLE program. This program is a 10 session, home-based interprofessional program that provides an occupational therapist, a nurse, and a handyworker to addresses older adults’ self-identified functional goals by enhancing individual capacity and the home environment. Taken together, these presentations can inform interventions and policies that improve the health and quality of life of older adults with disabilities.

scholarly journals Medicare Costs by Disability and Community-Dwelling Status

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 118-118
Author(s):  
Claire Ankuda ◽  
Katherine Ornstein
Keyword(s):  
Older Adults ◽  
Nursing Homes ◽  
Functional Disability ◽  
Population Level ◽  
Community Dwelling ◽  
Health Care Use ◽  
Expenditure Patterns ◽  
One Year ◽  
Medicare Costs ◽  
Medicare Expenditure

Abstract Understanding population-level Medicare expenditure patterns for older adults with functional disability is critical to focus supports to reduce costly and potentially burdensome health care use. We used the National Health and Aging Trends Study (NHATS) to assess quarterly Medicare expenditures over the 12 months following NHATS interview. We examine Medicare expenditure patterns for older adults in nursing homes (N=386), in the community and without disability (N=20,103), with disability and dementia (N=2,008), and with disability but not dementia (N=2,945). One-year mortality ranged from 2.0% for those without disability in the community to 25.9% for those residing in nursing homes. Among those surviving 1 year, Medicare expenditures the first quarter after NHATS survey ranged from $1,794 (95% CI $1,690-$1,898) for those with no disability to $5,177 (95% CI $4,535-$5,818) for those with disability and dementia. We assess trends over the following two years, and find that trajectories vary by clinical grouping.

scholarly journals Likelihood of Participation in Home-Based Cognitive Assessment: The Role of Subjective Cognitive Decline and Age

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 293-294
Author(s):  
Moriah Splonskowski ◽  
Holly Cooke ◽  
Claudia Jacova
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Old Age ◽  
Cognitive Assessment ◽  
Community Dwelling ◽  
Subjective Cognitive Decline ◽  
Cognitive State ◽  
Home Based ◽  
Increased Risk

Abstract Home-based cognitive assessment (HBCA) services are emerging as a convenient alternative to in-clinic cognitive assessment and may aid in mitigating barriers to detecting cognitive impairment (CI). It is unknown which older adults would be likely to participate in HBCA. Here we investigated the role of age and Subjective Cognitive Decline (SCD). SCD has demonstrated an increased risk for progression to CI/dementia. A nation-wide community-dwelling sample of 494 adults age 50+ were recruited via Amazon Mechanical Turk to complete an online survey assessing perceptions around HBCA and SCD. Our sample was 91.9% White and 66.8% female. It consisted of 174 respondents aged 50-60, 265 aged 61- 70, and 55 aged 71-79. Age groups were comparable with respect to their acceptance of cognitive assessment (Range 4-20, higher score=higher acceptance, 7.9±3.3, 8.15±3.2, 8.05±3.43) and SCD-Q total (43.1±5.8, 43.2±5.7, 43.3±5.7). Correlation analysis revealed a relationship between SCD-QSCD total and perceived likelihood of participation in HBCA for those ages 61-70 (r(263) = .222 p = .000), but not for ages 50-60 or 71-79 (r(172) = .102 p = .152; r(53) = -.102 p = .458). Our findings suggest that SCD influences the likelihood of participation in HBCA for older adults’ transitioning to old age (61-70). Findings show that for adults transitioning into old age (61-70), perceived cognitive state influences their likelihood of participation in HBCA. Importantly, concerns about CI/dementia may generate more favorable perceptions of HBCA for this group.

EFFECTS OF COMPUTERIZED COGNITIVE TRAINING ON GAIT SPEED IN COMMUNITY DWELLING OLDER ADULTS, A PILOT STUDY

2016 ◽  
pp. 1-6
Author(s):  
J. Blackwood ◽  
T. Houston
Keyword(s):  
Older Adults ◽  
Cognitive Training ◽  
Gait Speed ◽  
Independent Living ◽  
Functional Decline ◽  
Community Dwelling ◽  
Computerized Cognitive Training ◽  
Home Based ◽  
Improved Function ◽  
Community Dwelling Older Adults

Background: In older adults declines in gait speed have been identified as predictors of functional decline and have been found in those with cognitive dysfunction. Cognitive training interventions that emphasize addressing executive function (EF) have resulted in a transfer effect from training cognitive processes into improved function. However research examining the effects of an EF specific computerized cognitive training (CCT) program on gait speed (GS) is limited. Objectives: To compare the effects of a six week EF specific CCT program on GS in community dwelling older adults using a pretest/posttest experimental design with subgroup comparisons based on a cutoff GS of 1.0m/s. Setting: Home based Participants: Forty independent living older adults (>65 years) without diagnosed cognitive impairment participated in either the intervention or control groups. Intervention: A six week long progressively challenging EF focused CCT program was performed at home. Measurements: Demographic variables, cognitive function (Trail-Making Test Part B) and GS were measured at baseline at week 7. Between group comparisons were completed for the whole sample initially with subgroup comparisons performed based on participants’ initial GS (Slow walkers: GS<1.0m/s; Fast Walkers: GS>1.0m/s). Results: No differences in GS were found for the whole population, but subgroup analyses restricted to slow walkers demonstrated a statistically significant improvement in GS after 6 weeks of CCT (µ =0.33 m/s, p = 0.03). Other outcomes measures were not statistically different at posttest. Conclusions: Older adults who walk at speeds <1.0m/s may benefit from a progressively challenging CCT program when self-administered in the home.

scholarly journals A Pilot Study to Test the Feasibility of a Home Mobility Monitoring System in Community-Dwelling Older Adults

2019 ◽  
Vol 16 (9) ◽  
pp. 1512 ◽  
Author(s):  
Heesook Son ◽  
Hyerang Kim
Keyword(s):  
Older Adults ◽  
Monitoring System ◽  
Health Care Providers ◽  
Community Dwelling ◽  
Care Providers ◽  
Remote Communication ◽  
Baseline Activity ◽  
Home Based ◽  
Health Related ◽  
Community Dwelling Older Adults

Technology enables home-based personalized care through continuous, automated, real-time monitoring of a participant’s health condition and remote communication between health care providers and participants. Technology has been implemented in a variety of nursing practices. However, little is known about the use of home mobility monitoring systems in visiting nursing practice. Therefore, the current study tested the feasibility of a home mobility monitoring system as a supportive tool for monitoring daily activities in community-dwelling older adults. Daily mobility data were collected for 15 months via home-based mobility monitoring sensors among eight older adults living alone. Indoor sensor outputs were categorized into sleeping, indoor activities, and going out. Atypical patterns were identified with reference to baseline activity. Daily indoor activities were clearly differentiated by sensor outputs and sensor outputs discriminated atypical activity patterns. During the year of monitoring, a health-related issue was identified in a participant. Our findings indicate the feasibility of a home mobility monitoring system for remote, continuous, and automated assessment of a participant’s health-related mobility patterns. Such a system could be used as a supportive tool to detect and intervene in the case of problematic health issues.

scholarly journals Implementation of the mHealth App for Swallowing Tongue Pressure Strengthening Exercises in Older Adults (Preprint)

2020 ◽  
Author(s):  
HyangHee Kim ◽  
Nam-Bin Cho ◽  
Kyung Min Kim ◽  
Minji Kang ◽  
Jinwon Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Mobile Health ◽  
Intervention Program ◽  
Community Dwelling ◽  
Tongue Pressure ◽  
Post Intervention ◽  
Main Trial ◽  
Home Based ◽  
Term Maintenance

BACKGROUND Tongue pressure is one of the effective indices of swallowing function, which decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue strengthening therapy on tongue function. Tongue exercises utilizing mobile Health (mHealth) technologies may have tremendous potential in advancing healthcare in the digital age to be more efficient for people with limited resources, especially for older adults. OBJECTIVE The purpose of this study was to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention program aimed at improving the swallowing tongue pressure in older adults. METHODS We developed a mobile health (mHealth) app for intervention which was utilized for 8 weeks (3 times/day, 5 days/week, a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age: 75.7 years) who complained of swallowing difficulties. The app was used for three therapy maneuvers: effortful prolonged swallowing (EPS), effortful pitch glide (EPG), and effortful tongue rotation (ETR). Pre-intervention and post-intervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument (IOPI). We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12-week post-intervention. RESULTS Eight out of 11 participants adhered to the home-based 8-week app therapy program with optimal intervention dosage. At the main trial endpoint (i.e., 8-week) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median = 17.5 kPa at pre-intervention and 26.5 kPa at post-intervention; P < .05). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12-week post-intervention were not observed. CONCLUSIONS Since swallowing tongue pressure is closely related with dysphagia symptoms, the combined methods of EPS, EPG, and ETR training have positively affected swallowing tongue pressure with their use as indirect and direct exercises. The mHealth app is a promising platform which can be used to deliver effective therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size as well as long-term effects of the intervention program, further studies are warranted. INTERNATIONAL REGISTERED REPORT RR2-10.2196/19585

scholarly journals Home Care Resiliency during the COVID-19 Pandemic: Older Adult-Home Care Aide Dyads’ Perspectives

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 721-721
Author(s):  
Naoko Muramatsu ◽  
Lijuan Yin ◽  
Maria Caceres ◽  
Jordan Skowronski
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Healthcare Providers ◽  
Community Dwelling ◽  
Care Recipient ◽  
Work Related ◽  
Care Recipients ◽  
Acute And Chronic Stress ◽  
Home Based ◽  
Related Stress

Abstract Homecare has increased its value as an alternative to nursing homes and adapted to evolving COVID-19 challenges. However, little is known about how COVID-19 has impacted community-dwelling older adults who need assistance with daily activities, including dressing, cooking, and shopping. Guided by the stress process framework, this mixed-method study examined how older homecare recipients experienced the acute and chronic stress during the first eight months of the pandemic, focusing on the role of home care aides (HCAs) in the context of Medicaid-funded in-home services. Thirty-five dyads of care recipients and HCAs participated in a COVID telephone survey as part of a larger study. Care recipients were typically older minority (40% African American, 31% Latinx) women (77%). Their COVID-related anxiety level, assessed by a 6-item Spielberger State Anxiety Inventory (1 “not at all” to 4 “very much”), was 2.2 (SD=0.9). While COVID-19 drastically reduced contacts with family members and healthcare providers, HCAs continued to provide care in person. One care recipient said, “Fortunately, I still have my HCA come and that keeps me sane.” HCAs showed resilience while facing their own family- and work-related stress: “I have followed the rules and just adapted. (COVID) did not affect the activities for my client.” Some dyads, however, experienced care disruptions because of COVID infection or fear in one or both parties. COVID-19 has demonstrated homecare resilience at the person-, dyad-, and organization-levels, calling for equitable, sustainable home-based care for a growing number of older adults who desire to stay in the home.

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