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BACKGROUND: Factors associated with sleep quality have not been well examined in hospitalized older persons with dementia, who are at high risk for impaired sleep. The aim was to identify factors associated with sleep quality among hospitalized persons with dementia. METHODS: This secondary analysis used baseline data from a cluster randomized trial. Factors examined included delirium severity, pain, depression, behavioral and psychological symptoms of dementia (BPSD), and daytime physical activity. Multiple stepwise linear regressions evaluated factors related to dimensions of sleep quality (sleep duration, efficiency, latency, and fragmentation; measured by the MotionWatch 8 (MW8)). RESULTS: Increased daytime physical activity was associated with higher sleep duration (β = .164; 95% CI, .111 to .717; p = .008; 7.7% variance) and sleep efficiency (β = .158; 95% CI, .020 to .147; p = .010; 5.4% variance), and less sleep fragmentation (β = −.223; 95% CI, −.251 to −.077; p < .001; 10.4% variance). Higher BPSD was significantly associated with prolonged sleep latency (β = .130; 95% CI, .098 to 2.748; p = .035; 3.7% variance). CONCLUSIONS: Results suggest the need to encourage daytime physical activity and reduce or manage BPSD to improve sleep quality among hospitalized persons with dementia.

This manuscript provides the protocol for a National Institute of Aging funded cluster randomized clinical trial that focuses on helping nurses in acute care to engage patients with dementia in physical activity while hospitalized using an approach referred to as Function Focused Care. Physical activity is defined as bodily movement produced by skeletal muscles resulting in the expenditure of energy and includes functional tasks such as bathing and dressing, leisure activity, ambulation, and moderate and vigorous intensity physical activity such as dancing, bike riding, or walking up stairs (World Health Organization, 2021). The development of Function Focused Care for Acute Care (FFC-AC) was based on the Social Ecological Model and Social Cognitive Theory and includes four steps: (1) Environment and Policy Assessments; (2) Education; (3) Establishing Patient Goals; and (4) Mentoring and Motivating of Staff (all levels of nursing staff), Patients, and Families. Function Focused Care activities include motivating older patients to participate in bed mobility; personal care activities such as bathing, dressing, ambulating as they are able; and other types of physical activities. The integration of the intervention among the nurses on the units is guided by the Evidence Integration Triangle (EIT), which includes the participation of a Stakeholder team and practical outcome measures. The intervention is therefore referred to as FFC-AC-EIT. In addition to describing the protocol developed to test the effectiveness and feasibility of FFC-AC-EIT, a description of ways to overcome some of the barriers and challenges that can be encountered with this work is provided.

Randomized controlled trials are considered the most rigorous research design in efficacy and effectiveness research; however, such trials present numerous challenges that limit their applicability in real-world settings. As a consequence, pragmatic trials are increasingly viewed as a research design that overcomes some of these barriers with the potential to produce findings that are more reproducible. Although pragmatic methodology in long-term care is receiving increasing attention as an approach to improve successful dissemination and implementation, pragmatic trials present complexities of their own. To address these complexities and related issues, experts with experience conducting pragmatic trials, developing nursing home policy, participating in advocacy efforts, and providing clinical care in long-term care settings participated in a virtual consensus conference funded by the National Institute on Aging in Spring 2021. Participants identified 4 cross-cutting principles key to dissemination and implementation of pragmatic trial interventions: (1) stakeholder engagement, (2) diversity and inclusion, (3) organizational strain and readiness, and (4) learn from adaptations. Participants emphasized that implementation processes must be grounded in the perspectives of the people who will ultimately be responsible for implementing the intervention once it is proven to be effective. In addition, messaging must speak to long-term care staff and all others who have a stake in its outcomes. Although our understanding of dissemination and implementation strategies remains underdeveloped, this article is designed to guide long-term care researchers and community providers who are increasingly aware of the need for pragmatism in disseminating and implementing evidence-based care interventions.

Randomized controlled trials are considered the most rigorous research design in efficacy and effectiveness research; however, such trials present numerous challenges that limit their applicability in real-world settings. As a consequence, pragmatic trials are increasingly viewed as a research design that overcomes some of these barriers with the potential to produce data that are more reproducible. Although pragmatic methodology in long-term care is receiving increasing attention as an approach to improve successful dissemination and implementation, pragmatic trials present complexities of their own. To address these complexities and related issues, experts with experience conducting pragmatic trials, developing nursing home policy, participating in advocacy efforts, and providing clinical care in long-term care settings participated in a virtual consensus conference funded by the National Institute on Aging in Spring 2021. Participants recommended 4 cross-cutting principles key to dissemination and implementation of pragmatic trial interventions: (1) engage stakeholders, (2) ensure diversity and inclusion, (3) assess organizational strain and readiness, and (4) learn from adaptations. Specifically related to implementation, participants provided 2 recommendations: (1) integrate interventions into existing workflows and (2) maintain agility and responsiveness. Finally, participants had 3 recommendations specific to dissemination: (1) package the message for the audience, (2) engage diverse audiences, and (3) apply dissemination and diffusion tools. Participants emphasized that implementation processes must be grounded in the perspectives of the people who will ultimately be responsible for implementing the intervention once it is proven to be effective. In addition, messaging must speak to long-term care staff and all others who have a stake in its outcomes. Although our understanding of dissemination and implementation strategies remains underdeveloped, this article is designed to guide long-term care researchers and community providers who are increasingly aware of the need for pragmatism in disseminating and implementing evidence-based care interventions.

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.

BACKGROUND: Knee osteoarthritis affects nearly 30% of adults aged 60 or older and causes significant pain and disability. Walking is considered a “gold standard” treatment option for reducing knee osteoarthritis pain and maintaining joint mobility but does not reduce pain for all adults with knee osteoarthritis pain and may induce pain—particularly when starting a walking routine. The mechanism by which walking is helpful for knee osteoarthritis pain is unclear. Quantitative sensory testing has revealed that knee osteoarthritis pain has both peripheral and central components, which vary by individual. OBJECTIVE: This study’s purpose was to better understand the mechanisms underlying the value of walking for knee pain. METHODS: We conducted a pretest/posttest study using quantitative sensory testing to measure neurophysiological parameters and examined systemic protein signatures. Adults with knee osteoarthritis and healthy controls underwent quantitative sensory testing and blood draw for platelet proteomics before and after a 30-min walk at 100 steps/minute. RESULTS: A single 30-min walk moderately increased pressure pain sensitivity at the affected knee among persons with knee osteoarthritis. Healthy adults showed no difference in pain sensitivity. Protein signatures among participants with knee osteoarthritis indicated changes in inflammatory and immune pathways, including the complement system and SAA1 protein that coincided with changes in pain with walking and differed from healthy participants. DISCUSSION: One goal of developing individualized interventions for knee osteoarthritis pain is to elucidate the mechanisms by which self-management interventions affect pain. The addition of therapies that target the complement system or SAA1 expression may improve the pain sensitivity after a moderate walk for adults with knee osteoarthritis.

Background With the increase in Black nursing home residents, racial and ethnic disparities in quality of care have been raised. Purpose The purpose of this study was to evaluate racial disparities in care and outcomes over 12 months. Methods This was a secondary data analysis using data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia study. A total of 553 residents, 24% Black residents and 76% White residents, from 55 nursing homes were included. Results Differences favoring Black resident were noted in agitation, quality of life, inclusion of person-centered care approaches in care plans, and fewer falls and hospitalizations. Differences in quality-of-care interactions favored White residents. There were no differences in depression, resistiveness to care, function, pain, or transfers to the emergency department. Conclusions Disparities in clinical outcomes were small and generally favored Black versus White residents except for quality-of-care interactions.

Background and ObjectivesPet ownership or human–animal interaction has been associated with better health outcomes in individuals with disease or disability. We hypothesized that pet ownership, as well as dog ownership and cat ownership separately, are associated with maintaining physical function, and leisure time physical activity and that among dog owners, dog walking is associated with maintaining these outcomes for generally healthy community-dwelling older adults participating in the Baltimore Longitudinal Study of Aging.Research Design and MethodsA total of 637 men (44.1%) and women aged 50–100 years (M = 68.3, standard deviation [SD] = 9.6) completed a comprehensive pet ownership questionnaire that ascertained pet ownership history 10–13 years and had serial assessments of physical function every 1–4 years prior. Linear or generalized linear mixed models with time varying pet ownership were used to examine change in physical function over a mean of 7.5 years (range 1–13, SD = 3.6) according to pet ownership.ResultsPet owners (n = 185) were significantly younger (p < .001) and had fewer comorbidities (p = .03) than nonowners; thus, age and comorbidities were included as covariates in the longitudinal analyses. Physical function and leisure time physical activity declined with aging across all outcomes (p < .001); the decline was slower among pet owners in overall physical performance (p < .001), rapid gait speed (p = .03), usual gait speed (p = .032), cardiorespiratory fitness (p < .001), and physical well-being (p = .002) controlling for age and comorbidities. Changes in leisure time physical activities with aging did not differ between pet owners and nonowners. Dog walking was not independently related to the maintenance of physical function or leisure time physical activity with aging.Discussion and ImplicationsThis study provides the first longitudinal evidence that pet ownership is associated with maintained physical function among community-dwelling generally healthy older adults.

Persons with dementia are at high risk for hospital-acquired disability, associated with low physical activity during hospitalizations. To determine the effectiveness of efforts to increase physical activity, a valid and reliable measurement approach is required. Data from an ongoing cluster randomized clinical trial examined the feasibility and validity of the MotionWatch 8 (MW8) triaxial actigraphy device. The sample included 321 participants of which 259 (81%) were willing to wear the MW8 for 24 hr. Regression analysis revealed that time in low activity, β = 0.17, t(255) = 2.9, p = .004, and time in moderate activity, β = 0.14, t(255) = 2.4, p = .017, measured by the MW8, were associated with participants’ physical function. Engagement in moderate physical activity was associated with return to baseline function at discharge (Wald χ2 = 4.10, df = 1, p = .043). The study provides preliminary support for the feasibility and validity of the MW8 in hospitalized persons with dementia.

Care interactions are essential to understand and respond to resident needs in assisted living (AL). The factors that influence care interactions in AL have not been directly examined. In this study, we explored the factors associated with the quality of care interactions in AL. It was hypothesized that resident functional status, agitation, depression, and resistiveness to care as well as facility size and ownership would be significantly associated with the quality of care interactions in AL after controlling for resident demographics (age, gender, marital status), comorbidities, and cognition. To test the hypothesis, we utilized baseline data including 379 residents from the second and third cohorts recruited in a randomized trial titled ‘Dissemination and Implementation of Function Focused Care for Assisted Living Using the Evidence Integration Triangle’. Regression analysis was performed using a stepwise method. The care interactions were mostly positive (mean=6.3; range = 0-7). Resident agitation and facility ownership were significantly associated with care interactions and accounted for 8.2% of the variance. Increased resident agitation was associated with negative or neutral interaction while for-profit ownership was associated with positive interactions. To promote positive care interactions, staff should be educated about strategies to minimize resident agitation (e.g., calm posture and respectful listening) and encouraged to engage with residents using resident-centered care and communication approach. Findings also suggest the need to work towards optimizing care interactions in nonprofit stings. Future research could further explore the impact of facility-level factors (e.g., staffing ratios, staff longevity, and job satisfaction) on care interactions.

Emotional expressions in late-stage dementia have traditionally been studied within a deficit paradigm. Moving the narrative of the dementia trajectory from a solely negative pathological experience to one that acknowledges the potential for positive experiences aligns with international recommendations for living well with dementia. The purpose of this study was to extend prior research by examining the pattern of well-being using affect balance, the ratio of positive to negative affect, in nursing home residents living with dementia over 12 months and its association to factors that could potentially influence resident well-being. This study was a secondary analysis of baseline, 4 and 12-month data from a pragmatic clinical trial. A total of 536 residents with moderate to severe cognitive impairments from 55 nursing homes were included in the analyses. Results of the multivariable linear mixed model regression analysis indicated that resident function, the number of registered nurse hours devoted to care in the facility, and the quality of staff interaction predicted higher affect balance over time after controlling for other variables. The findings provide support for the utility of affect balance as a meaningful outcome measure of well-being for persons living with dementia. In addition, results point to specific interventions (i.e., maintaining/improving resident function, providing adequate nurse staffing levels, and improving staff communications skills) that can serve as the focus for both research and practice to help residents live well with dementia. Clinicaltrials.gov (NCT03014570).

Background Moderate to severe pain has been frequently reported in hospitalized older adults. Pain in hospitalized persons with dementia within the context of other common symptoms, functional decline, delirium, and behavioral and psychological symptoms of dementia (BPSD), has received little attention. Aims Describe the incidence of pain, the pharmacologic management of pain, and the association of pain with physical function, delirium, and BPSD in hospitalized persons with dementia. Design Descriptive, cross-sectional study. Setting Six medical units in three hospitals. Participants Baseline data from 299 hospitalized persons with dementia enrolled in the Family-centered Function-focused Care (Fam-FFC) cluster randomized trial. Methods Descriptive analyses of pain used the Pain Assessment in Advanced Dementia (PAINAD) scale and the use of medication for pain management. Linear regression analyses tested relationships between pain and:1) physical function (Barthel Index), 2) delirium severity (Confusion Assessment Method Severity Short Form) and 3) BPSD severity (Neuropsychiatric Inventory- Questionnaire). Results The majority of the sample was female (61.9%), non-Hispanic (98%), and Black (53.2%), with a mean age of 81.58 (SD=8.54).Of the 299 patients, 166 (56%) received pain medication. Of the 108 individuals who demonstrated pain, 40% (n=43) did not receive pain medication. When controlling for age, gender, cognition, and comorbidities, pain was significantly associated with function, delirium severity, and BPSD severity. Conclusions Results suggest that pain may be undertreated in hospitalized persons with dementia, and should be considered upon admission to optimize function, decrease delirium, and prevent or decrease BPSD.

There are many definitions for polypharmacy used within clinical practice and research and many factors contributing to this problem. Definitions vary from being based on the number of medications the older adult is taking to a more qualitative evaluation of the appropriateness of medication based on the benefit of the drug for a specific problem. For research purposes the definition is more commonly conceptualized as being equivalent to taking five or more medicines. Polypharmacy is noted to be presented in about 40% of older adults living in the community. Limited research has focused specifically on polypharmacy in assisted living settings. In addition to concerns about polypharmacy in assisted living there has also been a focus on the use of psychotropic medication and opioids in these settings as prevalence ranges from 53% to 68%. Although there are not regulations related to decreasing polypharmacy via deprescribing or to decrease use of psychotropics or opioids in assisted living, there are currently major initiatives in geriatrics to focus on these areas. This symposium will provide current data on medication use and polypharmacy among a large sample of 781 assisted living residents from 85 communities across three states and address the impact of a Function Focused Care approach on decreasing polypharmacy and use of psychotropics and opioids. Lastly data will be provided on the value of Deprescribing Networks to help decrease polypharmacy within these settings. The findings from this symposium will provide recommendations for future research as well as guidance for clinical practice.

This session will provide a description of the treatment fidelity (TF) plan from the Family-centered Function-focused Care (Fam-FFC) trial. Components of the TF plan, measures, procedures for implementation, and findings will be presented, and discussed within the context of the COVID-19 pandemic. The components of the Fam-FFC TF plan and results include: 1) Delivery based on completion of the steps in Fam-FFC ; 2) Receipt based on evidence of Staff knowledge of Fam-FFC (percentage of nursing staff that demonstrated test scores above 80%); 3) Enactment based on achievement of goals using the Goal Attainment Scale ; completion of the Fam-Path Audit of bedside goals and treatment plans, post-acute follow-up and plan update ; and evidence of Fam-FFC based on the Fam-FFC Behavior Checklist (80% staff performance of Fam-FFC). The TF plan demonstrated evidence of delivery, receipt and enactment of study activities. Findings will be used to develop an implementation trial.

Eating performance is the functional ability to get food and drink into the mouth. Nursing home residents with dementia commonly experience compromised eating performance and subsequent nutritional consequences. Resident characteristics including cognition, physical capacity, and functional ability are associated with eating performance. This study aimed to test the association between functional ability, behavioral symptoms, psychotropic medication use, and comorbidities and eating performance. This was a secondary analysis using baseline data from two randomized controlled trials testing the impact of Function Focused Care on function and behavioral symptoms between 2014-2020. A total of 889 residents with moderate-to-severe dementia (mean age 86.58 years, 72% female, 70% white, 69.5% severe dementia) from 67 nursing homes in two states were recruited. Eating performance (dependent variable) was measured using the single self-feeding item on the Barthel Index. Independent variables included functional ability (Barthel Index total score excluding self-feeding item score), behavioral symptoms (agitation, depression, resistiveness to care), and psychotropic medication use (anti-depression, sedative, anti-psychotics, anti-seizure, anti-anxiety), and comorbidities. Residents had on average 5 documented comorbidities (SD=3.06, range=0-12) and were on approximately 1 psychotropic medication (range=0-5, SD=1.24). Thirty-eight percent of residents were dependent in eating performance. Functional ability (OR=1.052, 95% CI=1.043,1.061, p

Age Friendly Health Systems (AFHSs) and Age Friendly Universities (AFUs) are distinct entities in the “Age Friendly” ecosystem. While Age Friendly entities function independently, they typically exist in close proximity (e.g., universities and community hospitals); yet they remain isolated in their Age Friendly efforts. We report on a collaboration between a mid-Atlantic Age Friendly University and a new AFHS using case study methodology. Our goal is to inform and inspire key stakeholders responsible for creating innovative healthy aging communities. The collaboration began with a shared stakeholder team who articulated focus areas and overlapping goals. A charter document was developed articulating commitments and responsibilities. Using a Quality Improvement (QI) approach, projects targeted the hospital’s older patient needs that linked to the AFHS 4 M’s of Matters, Medications, Mobility, and Mentation. University graduate students and faculty volunteered to teach and mentor hospital staff on the QI projects: 1) Get to Know Me Boards filled by staff caring for hospitalized older adults (Matters); 2) Medical Intensive Care Unit discharge opioid medication deprescribing (Medication); 3) UMove Mobility Screening addressing functional status (Mobility); 4) UB-2 Delirium Screening (Mentation). Data collection across projects demonstrated proof-of-concept and identified implementation challenges around communication, screening, data entry, and data extraction from electronic medical records. During Covid-19 pandemic, the collaboration allowed QI projects to conduct multiple Plan-Do-Check-Act cycles while contributing to the Age Friendly goals of both organizations. Partnerships between academic institutions and hospitals foster development of evidence- based healthy aging communities and provide opportunities for continuing education and research.

Objectives: This study examined differences in physical function, delirium, depressive symptoms, and behavioral and psychological symptoms of dementia (BPSD) in hospitalized African American and white older adults with dementia. Methods: This secondary data analysis using baseline data from an ongoing trial testing family-centered function-focused care included African American ( n = 159) and white persons ( n =135) with dementia. Results: A multivariate analysis of covariance showed that controlling for relevant demographic and health characteristics, African Americans with dementia had lower physical function, more delirium, and more depressive symptoms upon admission than white participants. There were no significant differences in BPSD between African American and white persons. Discussion: To our knowledge, this is the first study to examine racial differences in admission symptoms of hospitalized persons with dementia. While the findings are preliminary, they can be used to inform the design of future research, including identifying the causes of disparities.

Background This study tested the impact of Function Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) on: (1) care interactions between residents and direct care staff; and (2) behavior and psychological symptoms associated with dementia among residents. Design This was a randomized controlled trial. Setting A total of 59 assisted living facilities in Maryland, Pennsylvania, and Massachusetts participated. Participants The sample included 550 mostly White (98%), female (69%) residents with a mean age of 89.30 (standard deviation = 7.63) years. Intervention The four-step FFC-AL-EIT intervention was implemented by a function focused care nurse facilitator working with a facility champion over 12 months. The steps included: (1) environment and policy assessments; (2) education; (3) establishing resident function focused care service plans; and (4) mentoring and motivating. Measures Resident descriptive data (e.g., age, sex, education, and comorbidities), depression, agitation, resistiveness to care, and the quality of care interactions were obtained at baseline and 4 and 12 months. Treatment fidelity data included environment and policy assessments, performance of function focused care by staff, and service plan assessments. Results There was a significant positive treatment effect related to depression, agitation, resistiveness to care, and quality of care interactions with either less decline or some improvement in these behaviors and symptoms in the treatment versus control group. Conclusion The study provides some statistical support, which may not necessarily be clinically significant evidence, for psychosocial outcomes of residents and care interactions between staff and residents in assisted living settings.

Background and PurposeThe purpose of this study was to test the reliability and validity of the Knowledge of Person-Centered Behavioral Approaches for BPSD based on a Rasch analysis.MethodsThis study used baseline data from the Implementation of the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) clinical trial.ResultsA total 1,071 nurses completed the test. There was evidence of reliability (alpha coefficient of .99), construct validity with INFIT and OUTFIT statistics in the .6 to 1.4 range, and hypothesis testing with a significant correlation between the Knowledge of Person-Centered Behavioral Approaches for BPSD and positive care interactions.ConclusionsFuture use of the measure should include more challenging items to differentiate those very high in knowledge of person-centered behavioral approaches for BPSD.

The assisted living (AL) environment plays an important role in supporting residents’ satisfaction and helping them to age in place. The AL environment is multidimensional and has many interrelated components including staffing (e.g. direct care workers, nursing, activity staff), services provided (e.g. medical, mental health, pharmacy), amenities offered at the setting (e.g. beauty salon, library, exercise facilities), and the physical environment. Evidence suggests that aspects of the AL environment can enhance or detract from the physical function, well-being, social engagement, and behavioral outcomes among residents. The purpose of this study was to develop and test a multidimensional AL environment measurement model that includes indicators of staffing, services, amenities, and the physical environment. Baseline data was used from a study testing the Dissemination and Implementation of Function Focused Care in AL. A total of 54 AL facilities across three states were included in the sample. Settings ranged in size from 31 to 164 beds with an average size of 82.2 (SD=26.2) beds and the majority were for profit facilities (n=41, 74.5%). Structural equation modeling was used to test the proposed model. Results showed that the model fit the data (χ(2)/df=1.861, p

An effective clinical research effort in nursing homes to address prevention and treatment of COVID-19 faced overwhelming challenges. Under the Health Care Systems Research Network-Older Americans Independence Centers AGING Initiative, a multidisciplinary Stakeholder Advisory Panel was convened to develop recommendations to improve the capability of the clinical research enterprise in US nursing homes. The Panel considered the nursing home as a setting for clinical trials, reviewed the current state of clinical trials in nursing homes, and ultimately developed recommendations for the establishment of a nursing home clinical trials research network that would be centrally supported and administered. This report summarizes the Panel's recommendations, which were developed in alignment with the following core principles: build on available research infrastructure where appropriate; leverage existing productive partnerships of researchers with groups of nursing homes and nursing home corporations; encompass both efficacy and effectiveness clinical trials; be responsive to a broad range of stakeholders including nursing home residents and their care partners; be relevant to an expansive range of clinical and health care delivery research questions; be able to pivot as necessary to changing research priorities and circumstances; create a pathway for industry-sponsored research as appropriate; invest in strategies to increase diversity in study populations and the research workforce; and foster the development of the next generation of nursing home researchers.

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.

To help patients spend more time engaged in physical activities and avoid the complications that occur Function Focused Care for Acute Care was developed (FFC-AC-EIT). FFC-AC-EIT includes the implementation of four steps: (1) Environment and policy assessments; (2) Education of staff; (3) Establishing patient goals; and (4) Mentoring and motivating of staff, patients, and families. A total of 600 patients from 12 hospitals will be included. Eligibility of patients is based on being 55 years of age and older, admitted for a medical reasons excluding COVID-19, and demonstrating evidence of dementia. Outcome measures are obtained at baseline, discharge, 1, 6 and 12 months post discharge and include physical function, physical activity, pain and pain management, psychological and behavioral symptoms associated with dementia, delirium and adverse events (falls, rehospitalizations, nursing home admissions). Due to COVID-19 innovative approaches were implemented to be able to initiate and continue with the study. These included: identifying potential participants that were COVID-19 free off site; transitioning some intervention activities with staff to online; completing verbal consent with proxies versus face to face; adjusting follow up MotionWatch 8 deliveries and placements to be done without face to face interaction; and adjusting recruitment time periods and intervention activities to fit with intermittently high periods of COVID-19. This symposium will describe intervention challenges, solutions and lessons learned, describe an effective process and measurement model for identification of participants with dementia; and provide optimal ways to measure pain and physical activity among older adults with dementia.

The secondary aim of the study testing the impact of Function Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) was to decrease psychotropic medications and opioids among assisted living residents. Function Focused Care is a philosophy of care in which direct care workers are taught how to evaluate older adults' underlying function and physical activity and optimize their participation in all activities. This randomized controlled trial included 85 communities and 781 residents across three states. A total of 501 out of 794 participants (63%) received at least one psychotropic medication or opioid. Except for opioid use at four months, there was no significant difference in the intervention groups with regard to medication use at any time point. The findings suggest that encouraging participation in physical activity during all care interactions does not result in an increase in the need for and prescribing of psychotropic medications or opioids.

The Cornell Scale for Depression in Dementia (CSDD) was developed to measure depressive symptoms among older adults with dementia. The psychometric qualities of the CSDD have been inconsistent regarding the factor structure, with some studies showing a four-factor model and others a five-factor model. The purpose of this study was to test the factor structure of the CSDD as a measure of depression among a sample of assisted living residents. It was hypothesized that a four-factor version of the CSDD would provide a better fit than a five-factor version of the CSDD. The present study used baseline data from the Function-Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) intervention study. A total of 511 residents from 85 assisted living facilities were included in the analyses. Confirmatory factor analyses were conducted to examine the factor structure and a chi-square difference test was conducted to compare model fit. Three items were removed from both models due to small factor loadings. The chi-square difference test indicated that the five-factor model fit the data significantly better (χ2 = 796.08, ∆χ2= 22.86, ∆df = 4, p < .001) than the four-factor model, although both the five-factor and four-factor models produced very poor model fits. These findings may be due to the fact that the CSDD relies on information from caregivers, and the measure might benefit from including observational signs of depression. Future work should examine other factors or items that belong in a depression measure among assisted living residents.

When analysing data where little knowledge of relationships is available, exploratory structuring techniques, e.g., clustering and scaling techniques, are applied, using an inductive approach to construct analogies and thus suggest how to organize the data. These procedures in Health Service Research mainly focus on latent variables and are particularly used in the development of instruments or theories. Our symposium includes three presentations on research studies in which exploratory structural procedures were used for data analysis, that were considered appropriate for Health Service Research. Dr. Johannes Bergmann will present a concept mapping technique of the German Preferences for Everyday Living Inventory (PELI-D), for structuring the questionnaire from the perspective of professional nurses. This is a mixed methods participatory approach that combines interpretation and decisions by the researchers with a sequence of multivariate statistical analyses (multidimensional scaling, cluster analysis).. Jan Dreyer will present a Multiple Correspondence Analysis and Hierarchical Cluster Analysis as exploratory data reduction procedures. His aim was to identify types of home-based care arrangements for people living with dementia. To analyse the relationships between care arrangement variables, he performed Multiple Correspondence Analysis. To cluster the care arrangements, he performed Hierarchical Cluster Analysis. Anna Louisa Hoffmann will present an alternative, modified procedure of Multiple Correspondence analysis. Since Multiple Correspondence Analysis underestimates the true quality of data representation, she used Adjusted Multiple Correspondence Analysis to explore construct validity of the Dementia Policy Questionnaire (DemPol-Q). This procedure was considered appropriate to assign categorical variables to latent variables.

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.

Pet ownership (PO) or human-animal interaction (HAI) has been associated with better physical and mental health in individuals with existing disease or disability. In experimental studies, HAI improves some aspects of cognitive function. No research addresses HAI and longitudinal changes in cognitive function in older adults. We examined the relationship of PO to maintaining executive function (EF) within generally healthy community-dwelling older adults in the Baltimore Longitudinal Study of Aging (BLSA). We hypothesized less EF deterioration among pet owners than non-owners; and less deterioration among dog-walkers than owners who don’t walk their dogs. 637 women (55.9%) and men aged 50–100 years (M=68.3, SD=9.6) completed a PO questionnaire which ascertained ownership history and comprehensive examination every 1–4 years over 1–13 years (M=7.5, SD=3.6). Linear mixed models with time varying PO examined changes in EF according to PO. Pet owners (n=185) were younger (p < 0.001) and healthier (p=0.030) than non-owners; thus, age and comorbidities were included as covariates in the longitudinal analyses. EF, assessed using the Trail-Making Test (TMT), deteriorated with age (p’s < 0.001). Deterioration was less severe among pet owners than non-owners (TMT A: p < 0.001; B: p < 0.001; difference: p=0.042) and dog owners than non-owners (TMT A: p=0.025; B: p=0.009; difference: p=0.076), but not among cat owners than non-owners. Among dog owners (n=73), dog walkers experienced less deterioration than non-walkers (TMT A: p=0.156; B: p=0.001; difference: p < 0.001). This study provides the first longitudinal evidence that PO may contribute to maintaining EF among community-dwelling generally healthy older adults as they age.

Background Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care in nursing homes. The Evidence Integration Triangle (EIT)-4-BPSD in nursing homes was a pragmatic Hybrid III trial of an implementation strategy to help staff use evidence-based non-pharmacological interventions to prevent and manage BPSD. This study aimed to describe and explore the stakeholders’ perceptions of the process to implement the EIT-4-BPSD strategy including its utility, and the barriers and facilitators to implementation in real-world settings. Methods EIT-4-BPSD was a multi-layer implementation strategy that engaged nursing home stakeholder groups to define community specific goals towards reducing BPSD over a 12-month period. Stakeholder groups from nursing homes that completed all 12-months of the implementation strategy were invited to participate in this process evaluation study. Qualitative data from focus group transcripts were analyzed using a conventional content analysis. Emerging codes were sorted into categories, then organized in meaningful clusters based on the domains of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Results The EIT-4-BPSD implementation strategy was completed in 21 nursing homes; 93 stakeholders participated in focus groups. Over half of participating nursing homes reported meeting their BPSD goals as expected or more. Challenges, facilitators, and contextual factors reported by stakeholder members explains variability in the implementation of EIT-4-BPSD strategy in 11 key categories: family; staff; organizational; staff, environmental, and resident outcomes; utility of EIT resources; adoption barriers and facilitators; care process adaptations; and future planning. Conclusion Stakeholders offered guidance on salient factors influencing the feasibility and utility of EIT-4-BPSD adoption and implementation to consider in future implementation research that aims to improve behavioral well-being in NH residents living with dementia. Engagement of family and staff at all levels of the organization (Management, leadership, and direct care); and measurement of staff, environmental, and resident outcomes were perceived as critical for future implementation success. While regulations, finances, and competing demands on staff time were perceived as reducing implementation success. Trial Registration The Testing the Implementation of EIT-4-BPSD study was registered in the ClinicalTrials.gov (NCT03014570) January 9, 2017.

Hospitalized persons with dementia are at higher risk for functional decline and cognitive loss related to delirium. Family-centered, function-focused care (Fam-FFC) engages the family care partner in education and active participation in function-focused goal setting, implementation, and evaluation to support delirium prevention and abatement and return to baseline physical function. The purpose of the current study was to examine the association of function-focused goal attainment with two discharge outcomes, return to baseline physical function and delirium severity at discharge, in hospitalized persons with dementia. In the ongoing Fam-FFC clinical trial, the majority of goals ( N = 433) developed by 134 care partner/patient dyads and nurses address mobility, cognitive stimulation, and self-care. Regression techniques demonstrated that goal attainment was significantly associated with return to baseline function ( B = 0.826, Wald = 4.17 [1], p = 0.041) and lower delirium severity at discharge ( B = 0.175, t = 2.239, p = 0.027). Results support the contribution of family engagement in promoting functional recovery of hospitalized persons with dementia. [ Journal of Gerontological Nursing, 47 (9), 13–20.]