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As a method of research, pragmatic trials are recommended so as to generate results that are applicable to real-world care. This intent is especially important for the millions of older adults who receive long-term care in thousands of nursing homes and assisted living communities across the country-and many millions more around the globe. This article presents key points raised by experts participating in a conference funded by the National Institute of Aging held at the 2021 conference of the Society for Post-Acute and Long-term Care Medicine. The purpose of the conference was to convene leading clinicians, researchers, and industry partners to address special considerations of pragmatic trials in long-term care. Cross-cutting and unique challenges and solutions to conducting pragmatic trials were discussed focusing on 3 areas of clinical relevance to long-term care: (1) functional care and outcomes, (2) psychosocial care and quality of life, and (3) medical care and outcomes, with a special focus on persons with dementia. Challenges and innovative solutions were organized across the 9 domains of the revised Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) Tool, and future research recommendations for pragmatic trials in long-term care were identified.

As a method of research, pragmatic trials are recommended so as to generate results that are applicable to real-world care. This intent is especially important for the millions of older adults who receive long-term care in thousands of nursing homes and assisted living communities across the country-and many millions more around the globe. This article presents key points raised by experts participating in a conference funded by the National Institute of Aging held at the 2021 conference of the Society for Post-Acute and Long-term Care Medicine. The purpose of the conference was to convene leading clinicians, researchers, and industry partners to address special considerations of pragmatic trials in long-term care. Cross-cutting and unique challenges and solutions to conducting pragmatic trials were discussed focusing on 3 areas of clinical relevance to long-term care: (1) functional care and outcomes, (2) psychosocial care and quality of life, and (3) medical care and outcomes, with a special focus on persons with dementia. Challenges and innovative solutions were organized across the 9 domains of the revised Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) Tool, and future research recommendations for pragmatic trials in long-term care were identified.

Cognitive impairment has become epidemic in older adult population. The recent advent of tiny wearable and ambient devices, a.k.a Internet of Things (IoT) provides ample platforms for continuous functional and cognitive health assessment of older adults. In this paper, we design, implement and evaluate AutoCogniSys, a context-aware automated cognitive health assessment system, combining the sensing powers of wearable physiological (Electrodermal Activity, Photoplethysmography) and physical (Accelerometer, Object) sensors in conjunction with ambient sensors. We design appropriate signal processing and machine learning techniques, and develop an automatic cognitive health assessment system in a natural older adults living environment. We validate our approaches using two datasets: (i) a naturalistic sensor data streams related to Activities of Daily Living and mental arousal of 22 older adults recruited in a retirement community center, individually living in their own apartments using a customized inexpensive IoT system (IRB #HP-00064387) and (ii) a publicly available dataset for emotion detection. The performance of AutoCogniSys attests max. 93\% of accuracy in assessing cognitive health of older adults.

BackgroundBehavioral and psychological symptoms of dementia (BPSD) are prevalent in people with neurodegenerative diseases.PurposeIn this scoping review the Kales, Gitlin and Lykestos framework is used to answer the question: What high quality evidence exists for the patient, caregiver and environmental determinants of five specific BPSD: aggression, agitation, apathy, depression and psychosis?MethodAn a priori review protocol was developed; 692 of 6013 articles retrieved in the search were deemed eligible for review. Gough's Weight of Evidence Framework and the Cochrane Collaboration's tool for assessing risk of bias were used. The findings from 56 high quality/low bias articles are summarized.DiscussionEach symptom had its own set of determinants, but many were common across several symptoms: neurodegeneration, type of dementia, severity of cognitive impairments, and declining functional abilities, and to a lesser extent, caregiver burden and communication.ConclusionResearch and policy implications are relevant to the National Plan to Address Alzheimer's Disease.