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Cancer-related disability is a complex problem for older breast cancer survivors. One aspect of cancer-related disability is a survivor's inability to complete meaningful daily activities and engage in life roles, referred to as activity limitations and participation restrictions respectively. There is a limited understanding of how interventions influence activity limitations and participation restrictions in this population. A scoping review was undertaken to identify and characterize nonpharmacological interventions developed to address activity limitations and participation restrictions. A systematic search of electronic databases (Ovid Medline, Embase, EBSCO CINAHL, and Ovid PsycINFO) was conducted in April 2020 and updated October 2020. Eleven studies met inclusion criteria. Most frequently observed delivery features were in-person and one-on-one format. Six interventions incorporated telehealth delivery components. Interventions were often complex and varied in content. Exercise and behavioral strategies were among the most frequently used active ingredients. Activity limitations and participation restrictions were often secondary outcomes, and measures of these outcomes were varied in content and assessment method. Study samples were not representative of the current population of older adult breast cancer survivors. Future intervention research should clarify intervention delivery, content, and dose, prioritize comprehensive measurement of activity limitations and participation restrictions, as well as recruit and involve representative study samples to enhance generalizability of findings.

Purpose Many older breast cancer survivors experience long-term disability due to cancer and cancer-related treatments. However, less than 20% of older breast cancer survivors utilize cancer rehabilitation services to address cancer-related disability. Further understanding of survivor experiences may reveal strategies to improve uptake cancer rehabilitation services in the USA. Methods Older breast cancer survivors were recruited from university-based registries, previous breast cancer research studies at our institution, community support groups, and geriatric oncology clinics. Participants completed a brief online survey to capture demographic and clinical characteristics. Semi-structured telephone-based interviews were recorded, transcribed, and thematically analyzed. Interviews facilitated conversation about access to rehabilitation and indications for cancer rehabilitation. Results Participants (n = 14) were, on average, 71 years old, primarily White, and an average of 36.5 months post-diagnosis. Five participants had formally received rehabilitation for a cancer-related concern. Participants described seven factors that influenced utilization of cancer rehabilitation services: (1) emerging awareness of disability; (2) coping styles; (3) comparison of cancer experience with others; (4) provider interaction; (5) perceptions of cancer diagnosis; (6) social support; and (7) cost of rehabilitation. Conclusions Older breast cancer survivors consider multiple factors when determining utilization of cancer rehabilitation services. Development of shared decision-making tools addressing the seven described factors may enhance communication and referral to cancer rehabilitation services. Intervention research should adopt frameworks that enhance healthcare accessibility to improve relevance of intervention content and delivery features for older breast cancer survivors.

Objective Although decompressive laminectomy (DL) for lumbar spinal stenosis (LSS) is a common procedure among older adults, it is unclear whether surgical definitions of success translate into patient-defined success. Using goal attainment scaling (GAS) to compare goal achievement between individuals, we investigated the relationship between surgical-defined functional recovery and achievement of personalized goals in patients who underwent DL for LSS. Participants Twenty-eight community-dwelling veterans scheduled to undergo DL. Methods Participants were interviewed over the phone to set 1-year post-DL goals within 30 days before undergoing DL. Brigham Spinal Stenosis (BSS) score, comorbidities, cognitive function, and psychological factors also were assessed. GAS and BSS were repeated 1 year after DL. GAS scores were transformed into GAS-T scores (T-score transformation) to standardize achievement between patients and GAS-T change scores to compare study variables. Results Seventeen of 28 participants had successful DL outcomes by BSS standards, though none of the participants achieved all of their GAS goals, with follow-up GAS-T scores averaging 44.5 ± 16.8. All three BSS scales positively correlated with GAS-T change scores: severity change r = 0.52, P = 0.005; physical function change r = 0.51, P = 0.006; and satisfaction r = 0.70, P Conclusion There was congruent validity between GAS and the BSS in older veterans undergoing DL for LSS. Given the need for patient-centered care in older adults, future investigations exploring GAS in larger studies that target additional pain conditions and include participants with greater demographic diversity are warranted.

Background/aims Evidence-based inpatient caregiver training may ensure that caregiver needs are met and hospital readmission costs reduced. The aim of this study was to evaluate the feasibility of implementing a caregiver education model, Caring for Our Caregivers, within an inpatient brain injury programme. Methods A total of 32 adults were admitted to inpatient neurorehabilitation during the 7-week feasibility trial. The three-step Caring for Our Caregivers programme included evidence-based recommendations following a caregiver needs assessment, goal setting and hands-on training. Satisfaction levels and caregiver preparedness were assessed via a survey. Results The caregiver needs assessment and goal collaboration was completed within 5 days 66% of the time. Results indicated an even distribution of hands-on (47%) and discussion-based (53%) education. Caregivers and staff identified high levels of satisfaction with the programme. Conclusions Early engagement, collaborative goals and hands-on training of the family caregiver of a client with acquired brain injury during inpatient rehabilitation demonstrated initial feasibility with positive implications for caregiver satisfaction and community discharge.

The Pittsburgh Performance Fatigability Index (PPFI, higher=greater fatigability), a novel accelerometer-based performance fatigability measure, was recently developed for adults aged ≥60 years. We validated PPFI during a usual-paced 400m walk in 429 individuals enrolled in the Study of Muscle, Mobility and Aging (age=76.9±5.3years, 57.6% women, gait speed=1.0±0.2 m/s from 4-meter walk). PPFI quantifies percent of performance decrement (i.e., slowing down) during 400m walk by comparing area under the observed cadence trajectories to the hypothetical area that reflects sustaining maximum cadence for the entire walk. PPFI scores (mean=2.1%±2.5%, range: 0-21.7%) demonstrated convergent validity with Short Physical Performance Battery (SPPB, Pearson correlation (r)=-0.32) and mobility (time to walk 400m, r=0.47). PPFI scores discriminated higher versus lower physical function (SPPB: 1.6% (≥10) vs. 2.9% (

This qualitative study focused on understanding how to involve unpaid care partners (‘family members or friends’) of older adults who are participating in CAPABLE. Using field notes, focus groups, and key informant interviews, the study revealed considerations for involving care partners, including providing choices, defining roles, sharing information in a collaborative manner, and reinforcing knowledge and skills training. These findings can help guide organizations interested in involving care partners in their older adult programs.

Older adults frequently turn to care partners for support to remain in their homes for as long as possible. Yet, many evidence-based home and community programs to support ageing in place do not formally involve care partners. This study sought to understand how to involve care partners in the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program. A qualitative descriptive study was conducted. Framework analysis of multiple sources of data, including descriptions from stakeholders (N = 24) and available CAPABLE resources, provided the basis for understanding how to involve care partners in the program. Considerations for involving care partners when initiating, delivering and following the program were generated; namely, providing older adults' choices while screening for the program, defining roles and sharing information in a collaborative manner and reinforcing knowledge and skills training. Embracing these considerations in geriatric practice and research efforts is likely to help care partners' ability to provide assistance, thus enabling older adults to remain in their homes for as long as possible. Providers can use findings to better involve and support care partners in their delivery of programs to older adults. Researchers should further develop and test a care partner-supported CAPABLE program.

Many older breast cancer survivors experience long-term disability due to cancer and cancer-related treatments. However, less than 20% of older breast cancer survivors utilize cancer rehabilitation services to address cancer-related disability. Further understanding of survivor experiences may reveal strategies to improve uptake cancer rehabilitation services in the USA.Older breast cancer survivors were recruited from university-based registries, previous breast cancer research studies at our institution, community support groups, and geriatric oncology clinics. Participants completed a brief online survey to capture demographic and clinical characteristics. Semi-structured telephone-based interviews were recorded, transcribed, and thematically analyzed. Interviews facilitated conversation about access to rehabilitation and indications for cancer rehabilitation.Participants (n = 14) were, on average, 71 years old, primarily White, and an average of 36.5 months post-diagnosis. Five participants had formally received rehabilitation for a cancer-related concern. Participants described seven factors that influenced utilization of cancer rehabilitation services: (1) emerging awareness of disability; (2) coping styles; (3) comparison of cancer experience with others; (4) provider interaction; (5) perceptions of cancer diagnosis; (6) social support; and (7) cost of rehabilitation.Older breast cancer survivors consider multiple factors when determining utilization of cancer rehabilitation services. Development of shared decision-making tools addressing the seven described factors may enhance communication and referral to cancer rehabilitation services. Intervention research should adopt frameworks that enhance healthcare accessibility to improve relevance of intervention content and delivery features for older breast cancer survivors.

Older breast cancer survivors have difficulty accessing rehabilitation interventions addressing activity limitations. Stakeholder input may improve accessibility of interventions. We sought expert consensus on intervention content and delivery features (e.g., where, mode, duration) to inform development of more accessible interventions for this population.We conducted a modified Delphi process with patient, clinical, administrative, and research experts. In Round 1, experts evaluated content and delivery features according to domains of feasibility and prioritization. In Round 2, panelists were asked to re-rank or confer agreement of content and delivery features that met Round 1 consensus. Ranking was based on median score. Consensus was defined as a percentage of panelists that ranked an option within one unit of the median. For nominal data, consensus was defined as percent agreement.Panelists (n = 20) prioritized physical activity strategies (Median Rank: 2; Consensus: 85%) and adaptive skills training (3; 65%). Panelists also prioritized delivery through outpatient services (1; 100%), post-treatment (1; 100%), combination mode of delivery (100%), duration of three months or less (100%) and occurring one to two days per week (100%).Cancer rehabilitation interventions should be designed with input from stakeholders. The stakeholder intervention priorities identified in this study (e.g., content, setting, and mode) may improve relevance and accessibility of future cancer rehabilitation interventions. Interventions delivered in outpatient clinics and post-treatment using virtual and in-person visits may improve accessibility. Future research should examine the effectiveness and implementation of these intervention characteristics.

Interprofessional, collaborative health care is the ideal standard in geriatrics. Students’ interprofessional practice skills are limited in typical siloed education. An experiential, team-based geriatrics course was designed to improve health professions (HP) students’ knowledge, skills, and attitudes about interprofessional practice. Students (n=209) from dentistry, medicine, nursing, nutrition, occupational therapy, pharmacy, physician assistant, social work, and speech-language pathology were assigned to interprofessional (IP) and medical-student only teams. The Interprofessional Collaborative Competency Attainment Survey-Revised (ICCAS-R) was administered pre- and post-course, along with program evaluations. Seventy percent of students completed both pre- and post-surveys. ICCAS-R scores were analyzed comparing the impact of training for medical students (n=78) on IP teams and remaining HP students (n=58). Students rated themselves as improved on all six ICCAS-R subscales (paired t-tests, p < 0.05). Sixty-nine percent rated themselves as better able to collaborate interprofessionally. A competitive team-based learning exercise using gamification was rated as the most authentic skill-building interprofessional activity. Experiential learning where students worked with the same team helped to build interprofessional and teamwork skills. Findings will be used to improve authenticity of the clinical and teamwork content, increase the use of gamification as a teaching technique, and refine students’ practice of IP teamwork competencies.

Despite national efforts to improve nursing home (NH) quality, care remains variable. Health system efforts to drive improvement often begin with a sub-group of NHs before scaling up across the organization. Yet, there is limited evidence on who to target for the first group. This study addressed this gap by examining facility characteristics of early and late adopters within a multi-site pragmatic clinical trial. Data were obtained from the Organizational Readiness to Change Assessment (ORCA), which was completed by expert trainers, and Nursing Home Compare. Early and late adoption was operationalized according to Roger’s Diffusion of Innovations. Sixty-percent of NHs (n=12) were late adopters and 40% (n=8) were early adopters. Between group differences (p

Background Older adults are at higher risk for cardiovascular disease and to functional decline, often leading to deterioration and dependency. Cardiac rehabilitation (CR) provides opportunity to improve clinical and functional recovery, yet participation in CR decreases with age. Modified Application of CR in Older Adults (MACRO) is a National Institute on Aging (NIA)-funded pragmatic trial that responds to this gap by aiming to increase enrollment of older adults into CR and improving functional outcomes. This article describes the methodology and novel features of the MACRO trial. Methods Randomized, controlled trial of a coaching intervention (MACRO-I) vs. usual care for older adults (age ≥ 70 years) eligible for CR after an incident cardiac hospitalization. MACRO-I incorporates innovations including holistic risk assessments, flexible CR format (i.e., helping patients to select a CR design that aligns with their personal risks and preferences), motivational prompts, nutritional emphasis, facilitated deprescription, enhanced education, and home visits. Key modifications were necessitated by the COVID-19 pandemic, including switching from a performance-based primary endpoint (Short Physical Performance Battery) to a patient-reported measure (Activity Measure for Post-Acute Care Computerized Adaptive Testing). Changes prompted by COVID-19 maintain the original intent of the trial and provide key methodologic advantages. Conclusions MACRO is exploring a novel individualized coaching intervention to better enable older patients to participate in CR. Due to COVID-19 many aspects of the MACRO protocol required modification, but the primary objective of the trial is maintained and the updated protocol will more effectively achieve the original goals of the study.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The Community Aging in Place, Advancing Better Living for Elders (CAPABLE) Program is a successful evidence-based intervention involving an OT, a nurse, and a handyman to promote aging in place for older adults. This presentation reflects important adaptations identified by stakeholders for implementation of CAPABLE through an Area Agency on Aging for a non-Medicaid population and reinforces the importance of early stakeholder engagement in knowledge translation. Primary Author and Speaker: Pamela Toto Additional Authors and Speakers: Beth Fields Contributing Authors: Caylee Yanes

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Many evidence-based home and community programs designed to support aging in place do not include care partners, including the well-known Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program. How OT practitioners can include care partners in CAPABLE and which strategies may work best for care partners are currently being explored. This presentation will discuss recent evidence on how to adapt CAPABLE to include care partners. Primary Author and Speaker: Beth Fields Additional Authors and Speakers: Pamela Toto Contributing Authors: Molly Ennis, Caylee Yanes

OBJECTIVE: The objective of the current investigation was to explore performance-based predictors of decline in the performance quality of everyday tasks as a first step for early identification, screening, and referral to minimize disability in community-dwelling older adults. METHOD: This was a secondary analysis of data from 256 community-based older women. Mobility, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) were measured using the Performance Assessment of Self-Care Skills (PASS). Logistic regression models explored cognitive and motor predictors of performance quality while controlling for demographics and diagnoses. RESULTS: Functional reach (p =.049) and cognition (p =.012) were predictive of mobility quality, whereas balance (p =.007) and the Keitel Function (p =.005) were predictive of ADL quality. Manipulation and cognitive measures were predictive of cognitive and physical IADL quality. DISCUSSION: Cognitive and physical screens are both important to identify older adults at risk for disability.© The Author(s) 2016. Language: en

Older adults frequently turn to informal caregivers for support to age independently in their home as long as possible. Yet, many evidence-based programs designed to support aging in place do not include caregivers, including the well-known Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program. The purpose of this qualitative study was to adapt CAPABLE to include caregivers using a grounded theory approach. Data collection occurred with stakeholders from an Area Agency on Aging (AAA) in Pennsylvania. Two, 60-minute focus groups were conducted with frontline providers (n=7) and administrators (n=7). Eight, 30-minute individual interviews were conducted with AAA consumers including older adults and their caregivers. Constant comparative analysis of the data were completed using NVivo 12 Pro. Stakeholders described three considerations for adapting CAPABLE to include caregivers: older adult preference and caregiver willingness, clear guidelines and expectations, and hands-on training. Older adults and caregivers recognized the need to “allow them to decide when and why family should be involved in the program.” Frontline providers and administrators explained the importance of “determining whether older adults and caregivers should have shared or separate goals for the program.” All stakeholders expressed that including caregivers would “reaffirm the hands-on training like fall prevention.” These perspectives shed light on how and why to include caregivers in CAPABLE. Information gleaned from this study may help researchers think about ways in which to adapt other evidence-based programs to include caregivers, and help healthcare providers target and support caregivers in the delivery of their services.

Community Aging in Place, Advancing Better Living for Elders (CAPABLE) is an interdisciplinary evidence-based intervention for reducing disability, reducing cost, and promoting aging in place for older adults who qualify for Medicaid services. However, implementation of CAPABLE through existing community services and with different older adult populations may require adaptations based on stakeholder input. The purpose of this qualitative study was to adapt CAPABLE for implementation through an Area Agency on Aging (AAA) targeting older adults with disability but who do not meet thresholds for Medicaid services. Data collection occurred with stakeholders from a single AAA. Two, 60-minute focus groups were conducted with frontline providers (n=7) and administrators (n=7). Thematic analysis of the data were completed using NVivo 12 Pro. Stakeholders described three themes to consider for implementing CAPABLE in their AAA: screening and referral process, eligibility, and team meetings. Frontline providers recognized the need to allow care managers “to decide who would be most appropriate for the program because they have a better understanding of the person, their family, and home environment.” Administrators supported expanding eligibility requirements, “Could we offer the program to someone even if they were recently hospitalized?” All stakeholders expressed that an initial interdisciplinary team meeting could be beneficial for goal setting, “If the team and consumer could be together for the first meeting that could save time and help generate ideas for goals.” These perspectives affirm the importance of early stakeholder engagement in adapting to adopt evidence-based programs into “real-world” settings.

Objective: Examine the feasibility and benefit of integrating occupational therapy (OT) into a long-term services and supports (LTSS) care coordination program for aging in place. Method: Clients referred to OT were evaluated with the In-Home Occupational Performance Evaluation and received education on strategies for aging in place. Clients who indicated readiness for change set personalized goals to improve daily functioning and received 4 additional OT visits. Results: 87% of feasibility benchmarks were met. 23 clients were referred, and 16 clients were evaluated; 37.5% of those evaluated indicated readiness for change, establishing 18 goals with 100% goal attainment. Conclusion: Integration of OT into a LTSS program was feasible. Benefits included a performance-based evaluation that revealed personal factors as barriers to aging in place and access to OT to maximize independence. By helping older adults reduce disability, OT may be a solution to the growing imbalance between LTSS resources and population needs.

Purpose: Individuals with traumatic brain injury (TBI) often experience difficulties in performing kitchen-related sequencing tasks due to cognitive deficits. The primary aim of this study is to examine the feasibility of a context-aware automatic prompting system in assisting individuals with TBI in multi-step cooking tasks.Method: Sixteen individuals with TBI participated in the study. A randomized cross-over design was used to compare the automatic prompting method with a conventional user-controlled method through a tablet device. Participant performance under each prompting method was assessed using the Performance Assessment of Self-Care Skills in terms of independence, safety, and adequacy. Subjective workload and qualitative feedback were also collected.Results: The automatic method, when compared with the user-controlled method, significantly decreased the amount of external assistance required by participants, received higher ratings in user perceived ease-of-use, and was considered less stressful for participants. However, the user-controlled method showed strengths in offering participants more flexibility in terms of controlling on the timing of prompts.Conclusions: The results provided insight into the potential benefits and user perceptions of a context-aware prompting system. The information could contribute to the future development of advanced prompting technology for people with cognitive impairments in completing sequential tasks.Implications for RehabilitationFor people with traumatic brain injury, the context-aware prompting method showed advantages in improving user performance, receiving better ratings on ease-of-use, and decreasing stress levels, compared to the user-controlled prompting method in completing multi-step cooking tasks.Future prompting systems for people with cognitive impairments may allow users to control the pace of prompting and use sensing information as back-up assistance in critical situations. In this way, the system may help users monitor their actions and offer confirmations, especially at steps with safety concerns, thus enhancing the sense of security and reducing the stress from self-monitoring.

This single-group repeated-measures pilot study evaluated the effects of a 10-wk, multicomponent, best-practice exercise program on physical activity, performance of activities of daily living (ADLs), physical performance, and depression in community-dwelling older adults from low-income households (N = 15). Comparison of pretest and posttest scores using a one-tailed paired-samples t test showed improvement (p < .05) for 2 of 3 ADL domains on the Activity Measure–Post Acute Care and for 6 physical-performance measures of the Senior Fitness Test. Repeated-measures ANOVA revealed significant main effects for 3 of 8 physical activity measures using the Yale Physical Activity Scale. Retention rate was 78.9%, and the adherence rate for group sessions was 89.7%. Results suggest that participation in a multicomponent, best-practice physical activity program may positively affect sedentary, community-dwelling older adults’ physical activity, ADL performance, and physical performance.

Reducing disability in older adults has become a goal of major importance. Defined as the difficulty or inability to carry out activities and roles necessary for independent living, disability increases burden of care, precipitates substantial use of community resources and challenges an older adult’s ability to age in place. Disability in older adults is challenging, common, and costly. Data from the National Health and Aging Trends Study indicates nearly half of older adults in the United States have difficulty or receive help with daily activities, with ethnic minorities and persons of low income most likely to experience disability and related adverse events. Geriatric primary care offers an opportune setting for early detection of disability risk and intervention for older adults. Primary care services can include health promotion, disease prevention, health maintenance, self-management, counseling, patient education, diagnosis and treatment of acute and chronic illnesses through delivery in a variety of health care settings. The effort to shift management of late-life disability to primary care is fueled by federal legislation and a growing body of evidence that suggests a preventative approach to disability is a more cost-effective strategy that yields positive outcomes. This symposium highlights evidence-based strategies for early detection of disability risk and intervention to reduce disability and falls through a primary care approach.

OBJECTIVE. We examined the feasibility and benefit of integrating occupational therapy into a long-term services and supports (LTSS) care coordination program for aging in place. METHOD. Clients referred to occupational therapy during a 16-wk trial were evaluated with the In-Home Occupational Performance Evaluation and received education on strategies for aging in place. Clients who indicated readiness for change were assisted in setting personalized goals with goal attainment scaling and received four additional occupational therapy visits. RESULTS. Of the program’s feasibility benchmarks, 87% were met. Twenty-three clients were referred, and 16 clients were evaluated; 37.5% of those evaluated indicated readiness for change, establishing 18 goals with 100% goal attainment. CONCLUSION. Integration of occupational therapy into an LTSS care coordination program was feasible. Benefits of adding occupational therapy included a performance-based evaluation that revealed personal factors as barriers to aging in place and gave access to a client-centered service to maximize independence.

Background: Preclinical disability is a transitional state between the onset of impairment in functioning and dependence in activities of daily life (i.e. disability). Preclinical disability in older adults can serve as an early warning and critical intervention point for prevention of further decline and adverse events. However, methods for identifying preclinical disability in older adults are not well developed and have been limited to self-report.

Objective Evaluate the feasibility of generating patient-centered goals using GAS with older adults who have multiple chronic conditions, recruited through primary care. Method Adults age 65+ (N = 27) were recruited from a geriatric primary care center. Participants were asked to identify 2–4 activity-based goals and set attainment levels using GAS. At 8 weeks, participants were asked to rate current level of their goal performance. Physician surveys were used to evaluate if goals were realistic and feasible, and patient surveys were implemented to evaluate satisfaction. GAS T-scores were used to quantify change in goal achievement. Results Ninety-three percent (n = 25) of participants were able to establish a minimum of two goals using GAS. 100% of participants were able to rate goal performance at follow-up. Physician survey results identified 100% of goals realistic and 93% achievable and 100% of participants were either neutral or satisfied with the process. Significant improvement was reported in GAS change scores (t(24) = 6.54, p Conclusion Findings support the feasibility of GAS for older adults with multiple chronic conditions in geriatric primary care as a strategy to facilitate patient-centered care and suggest that the process of personalized goal-setting itself may facilitate goal attainment.

To determine clients' capacity for community living, occupational therapists must use measures that capture the person—task–environment transaction and compare clients' task performance to a performance standard. The Performance Assessment of Self-care Skills, a performance-based, criterion-referenced, observational tool, fulfills this purpose. In this practice analysis, using data from this tool from multiple clinical studies (N = 941), the authors describe tasks that clients from various diagnostic populations could and could not perform independently and safely. For clinicians, the Performance Assessment of Self-care Skills can be used to identify which daily tasks are compromised and the point of task breakdown, as well as to provide guidance about potential interventions.

Date Presented 4/8/2016 The prevalence of frailty was measured by the Survey of Health, Ageing, and Retirement in Europe Frailty Instrument (SHARE–FI) among older adults (N = 170) receiving occupational therapy services in a skilled nursing facility. Of these, 72.9% (n = 124) were frail upon evaluation. The results support occupational therapists’ use of the SHARE–FI to distinguish frailty from other clinical conditions to provide effective services. Primary Author and Speaker: Kelly Dickson Contributing Author: Pamela Toto