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BackgroundThere continues to be a belief among nurses, patients, and families that physical activity increases the risk of falling.PurposeThe purpose of this study was to test the hypothesis that controlling for age, function, cognition, medication use, gender, comorbidities, and cognition, residents who are exposed to Function Focused Care for Assisted Living (FFC-AL-EIT) and engage in moderate levels of physical activity would not be more likely to fall.MethodsThis was a secondary data analysis using data from the first two cohorts of a randomized trial testing FFC-AL-EIT in the United States.ResultsThe study included 381 residents, the majority of whom were female (70%), white (97%), with a mean age of 87.72 (standard deviation = 7.47). Those who engaged in more moderate-intensity physical activity were 1% less likely to fall (odds ratio = .99, p = .03). There was no significant association between exposure to function focused care and falling (odds ratio = 1.58, p = .09).ConclusionThere was no indication that those who were exposed to function focused care or those who engaged in moderate-level physical activity were more likely to fall. In fact, engaging in moderate-level physical activity was noted to be slightly protective of falling.

Well-being is an important outcome for people with dementia. The current study is a secondary analysis of baseline data from an ongoing pragmatic trial. Affect balance, the ratio of positive to negative affect, was used as a measure of well-being, and factors related to it were examined in a sample of 325 nursing home residents. Measures of staff interaction during caregiving, staff knowledge of person-centered approaches for dementia care, staff hours of care, the physical environment, person-centered policies, resident function, and quality of life were obtained using direct observation, staff interview, and medical chart review. The results of the quantile multivariable regression analysis indicated that positive staff interaction and higher resident function were significantly associated with higher affect balance after controlling for other variables. The findings have heuristic value for the development of conceptual frameworks that focus on meaningful outcomes for residents with dementia and future research. [ Research in Gerontological Nursing, 13 (1), 21–30.]

The purpose of the current study was to test for gender differences among residents living in assisted living settings. This was a secondary data analysis using data from the first 64 facilities participating in the ongoing Function Focused Care for Assisted Living study using the Evidence Integration Triangle (FFC-AL-EIT). A total of 593 residents were recruited. Differences by gender with regard to function, physical activity, falls, total number of medications, and satisfaction with assisted living were tested using multivariate analysis of variance. There were 166 (28%) men and 427 (72%) women with a mean age of 88 ( SD = 7.5 years). Participants had five ( SD = 2) comorbidities and took on average 6.88 medications ( SD = 3.47). Participants had moderate functional impairment with a mean of 64.13 ( SD = 19.09) on the Barthel Index and engaged in 43.8 ( SD = 76.12) minutes daily of moderate level physical activity. Women reported higher satisfaction with activities (4.32 [ SD = 1.14]) than men (3.85 [ SD = 1.51]), and women received more medications than men (7.09 [ SD = 3.51] vs. 6.34 [ SD = 3.31]). Current study findings suggest that deprescribing may be particularly important for women versus men and focusing on expanding activity options to include those preferred by men should be considered in assisted living settings. [ Research in Gerontological Nursing, 13 (1), 31–40.]

OBJECTIVES: This study described current use and predictors of psychotropics among residents with moderate to severe cognitive impairment. DESIGN: This was a secondary data analysis using baseline data from the first 341 residents in an ongoing trial. MEASURES: Predictive measures included age, gender, race, depressive symptoms, agitation, resistiveness to care, depression, cognition, pain, comorbidities, facility factors and state. RESULTS: Overall 63% (n=211) received at least one psychotropic medication, 16% (n=52) an anti-seizure medication, 23% (n=77) an anxiolytic, 30% (n=99) an antidepressant, 2% (n=8) a sedative hypnotic, 28% (n=93) an antipsychotic medication, and 9% (n=29) an opioid. Testing of models explained 9 to 15% of psychotropic medication use. CONCLUSIONS/IMPLICATIONS: There were high rates of psychotropic medication use and a limited association between demographic factors, behavioral symptoms, and psychotropic medication use. Continued research is needed to explore the impact of deprescribing, person centered behavioral interventions, and beliefs of providers on psychotropic medication use.

OBJECTIVE: The purpose of this study was to test the effectiveness of the Function and Behavior Focused Care for the Cognitively Impaired (FBFC-CI) intervention on function, physical activity and behavioral symptoms among nursing home residents with dementia, and to explore the adoption of the intervention at the facility level. DESIGN: This study was a clustered, randomized controlled trial with a repeated measures design that was implemented in 12 nursing homes randomized to either treatment (Function and Behavior Focused Care for the Cognitively Impaired Intervention (FBFC-CI) or educational control (Function and Behavior Focused Care Education (FBFC-ED). SETTING AND PARTICIPANTS: 12 nursing homes (6 treatment and 6 control) and 336 residents (173 treatment and 163 control) with moderate to severe cognitive impairment. MEASURES: Outcomes included functional ability (Barthel Index), physical activity (actigraphy and survey), behavioral symptoms (Resistiveness to Care Scale, Cohen Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia) and psychotropic medication use. RESULTS: The participants 82.6 (SD=10.1) years of age, mostly female and were moderate to severely cognitively impaired (MMSE of 7.8, SD=5.1). There was a significantly greater increase in time spent in total activity (p=0.004), moderate activity (p=0.012) light activity (p=0.002), and a decrease in resistivenes to care (p=0.004) in the treatment versus control group at 4 months. There was no change in mood, agitation, and the use of psychotropic medications. There was some evidence of adoption of the intervention in treatment sites. CONCLUSIONS AND IMPLICATIONS: This study provides some support for the use of the FBFC-CI intervention to increase time spent in physical activity and decrease resistive behaviors during care commonly noted among nursing home residents with moderate to severe cognitive impairment.

Many countries are seeking to improve health care delivery by reviewing the roles of health professionals, including nurses. Developing new and more advanced roles for nurses could improve access to care in the face of a limited or diminishing supply of doctors and growing health care demand. The development of new nursing roles varies greatly from country to country. The United States and Canada established “nurse practitioners” (NPs) in the mid-1960s. The United Kingdom and Finland also have a long experience in using different forms of collaboration between doctors and nurses. In other countries, such as Australia, NPs were endorsed more recently in 2000. In France, Belgium, or Singapore, the formal recognition of advanced practice nurses is still in its infancy, whereas in other countries, such as Japan or China, advanced practice nurses are not licensed titles. The aims of this article were to define precisely what is meant by the term “advanced practice nurse (APN),” describe the state of development of APN roles, and review the main factors motivating the implementation of APN in different countries. Then, we examine the main factors that have hindered the development of APN roles. Finally, we explain the need for advanced practice roles in geriatrics.

Background and PurposeThe purpose of this study was to test the reliability and validity of the Quality of Interaction Survey (QuIS) using a quantification scoring approach.MethodsBaseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) study was used.ResultsA total of 553 residents participated. There was evidence of inter-rater reliability with Kappa scores of .86 to 1.00 and internal consistency based on the Rasch analysis (item reliability of .98). There was some support for validity based on item fit and hypothesis testing as resistiveness to care was significantly associated with total QuIS scores.ConclusionThis study supports the use of the quantified QuIS to evaluate the quality of interactions over time and to test interventions to improve interactions.

Background Resistiveness to care is behavior that prevents or interferes with caregivers’ performing or assisting with activities of daily living and puts residents at risk for inappropriate use of antipsychotic drugs, other restraining interventions, social isolation, and physical abuse. The purpose of this study was to establish the psychometric properties of a previously developed Resistiveness to Care measure. Procedures This was a descriptive study using baseline data from an ongoing randomized controlled trial testing a Function and Behavior Focused Care (FBFC) intervention. Residents were eligible to participate if they were 55 years of age or older, had a Mini-Mental State Exam (MMSE) score of 15 or less, and were not enrolled in hospice or admitted for subacute care. Descriptive information included age, race, gender, cognitive status, and marital status. In addition to the Resistance to Care Scale, the Barthel Index, the Physical Activity Survey in Long Term Care (PAS-LTC), and the Cohen-Mansfield Agitation Inventory (CMAI) were completed. Psychometric testing was done using Rasch analysis and the Winsteps statistical program. Main findings The participants were moderate to severely cognitively impaired (MMSE of 7.23), functionally dependent (Barthel Index 47.31, SD 27.59), and engaged in only 134.17 (SD = 207.32) minutes of physical activity daily. Reliability was supported based on a Cronbach alpha of 0.84 and the DIF analysis, as there was no difference in function of the items between male and female participants. Validity was supported as all items fit the measurement model based on INFIT and OUTFIT statistics. Conclusions The findings support the reliability and validity of the Resistiveness to Care Scale for use with older adults with dementia in nursing home settings. Future work with the measure may benefit from the addition of items that are easier to endorse with regard to resistiveness to care (shutting eyes or spitting out food may be useful additions).

Background and Purpose: The purpose of this pilot study was to test the reliability and validity of the MotionWatch 8 with older adults. Methods: Participants wore the MotionWatch 8 for 3 days, completed a diary of activities and the Borg Rating of Perceived Exertion (RPE) scale. Results: Evidence of reliability and validity was supported because there was no difference in daily level of activity and that recorded physical activity matched the activity counts. There was a significant difference in Borg RPE scale scores between the sedentary group (Borg RPE scale = 8.6,SD= 3.0) and those with some level of activity (Borg RPE scale = 9.9,SD= 2.3;F= 5.72,p= .02). Conclusion: The findings provide preliminary support for the reliability and validity of the MotionWatch 8 when used with older adults.

Pain has a significant effect on physical and psychological outcomes for older adults post orthopedic trauma. The purpose of this study was to describe the management of pain among older trauma patients and consider differences between those who received 3 or more dosages daily of opioids versus those who did not. This was a secondary data analysis using data from an intervention study testing the effect of Function Focused Care among older orthopedic trauma patients (FFC-AC). The FFC-AC study was done on trauma units in two acute care settings designated as Level I or II trauma centers from September 2014 to September 2015. All participants from the parent FFC-AC study were included. Data collection for the parent study was done within 24 hours of admission and within 24 hours of discharge and included demographics, medications, assessment of function, physical activity, mood, physical resilience, and whether the patient had pain and their pain intensity. Patient records included all 89 individuals from the parent study, 59 (66%) of whom were female and 82 (92%) were white. Records indicated that those who received more than three dosages per day of opioids had a shorter length of stay, were younger, had more intense pain, and were more resilient compared with those who received less than three dosages per day. This secondary data analysis provides support for the importance of considering pain and pain management among older adults post trauma.

Behavioral and psychological symptoms of dementia are common in nursing home residents, and the Centers for Medicare and Medicaid Services now require that nonpharmacological interventions be used as a first-line treatment. Few staff know how to implement these interventions. The purpose of this study was to pilot test an implementation strategy, Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD), which was developed to help staff integrate behavioral interventions into routine care. The EIT-4-BPSD was implemented in 2 nursing homes, and 21 residents were recruited. A research nurse facilitator worked with facility champions and a stakeholder team to implement the 4 steps of EIT-4-BPSD. There was evidence of reach to all staff; effectiveness with improvement in residents’ quality of life and a decrease in agitation; adoption based on the environment, policy, and care plan changes; and implementation and plans for maintenance beyond the 6-month intervention period.

Background Measurement of physical function post hip fracture has been conceptualized using multiple different measures. Purpose This study tested a comprehensive measurement model of physical function. Design This was a descriptive secondary data analysis including 168 men and 171 women post hip fracture. Methods Using structural equation modeling, a measurement model of physical function which included grip strength, activities of daily living, instrumental activities of daily living, and performance was tested for fit at 2 and 12 months post hip fracture, and among male and female participants. Validity of the measurement model of physical function was evaluated based on how well the model explained physical activity, exercise, and social activities post hip fracture. Findings The measurement model of physical function fit the data. The amount of variance the model or individual factors of the model explained varied depending on the activity. Conclusion Decisions about the ideal way in which to measure physical function should be based on outcomes considered and participants. Clinical Relevance The measurement model of physical function is a reliable and valid method to comprehensively measure physical function across the hip fracture recovery trajectory.

Post–hip fracture generalized pain can lead to a progressive decline in function and greater disability. The purpose of this study was to explore the factors that influence pain among older adults post–hip fracture, including genetic variability, and evaluate whether pain directly or indirectly influenced upper and lower extremity function. This was a secondary data analysis using data from the first 200 participants in a Baltimore Hip Study (BHS), BHS-7. Assessments were done at 2 months post–hip fracture and included age, sex, marital status, education, cognitive status, comorbidities, body mass index (BMI), upper and lower extremity function, single nucleotide polymorphisms (SNPs) from 10 candidate genes, and total areas of pain and pain intensity. Model testing was done using the AMOS statistical program. The full sample included 172 participants with an average age of 81. Fifty percent were female and the majority was Caucasian (93%). Model testing was done on 144 individuals who completed 2 month surveys. Across all models, age, cognition, and BMI were significantly associated with total areas of pain. Thirty SNPs from five genes ( BDNF, FKBP5, NTRK2, NTRK3, and OXTR ) were associated with areas of pain and/or pain intensity. Together, age, cognition, BMI, and the SNP from one of the five genes explained 25% of total areas of pain and 15% of pain intensity. Only age and cognition were significantly associated with lower extremity function, and only cognition was significantly associated with upper extremity function. The full model was partially supported in this study. Our genetic findings related to pain expand prior reports related to BDNF and NTRK2 .

The Volunteering-in-Place (VIP) Program was developed to provide individualized meaningful volunteer activities matched to interests and capabilities for older adults with MCI in assisted living. The purposes of this single-site pre-test/post-test pilot study were to (1) establish feasibility of the VIP Program based on treatment fidelity (design, treatment, delivery, enactment); and (2) evaluate preliminary efficacy via improvement in psychological health (depressive symptoms, usefulness, purpose, resilience, and life satisfaction) and decreased sedentary activity (survey and Fitbit) at 3 and 6 months. Ten residents participated. The majority was white, female and educated, and on average 88 years old. The VIP Program was feasible and most participants continued to volunteer at 6 months. There were non-significant improvements in depressive symptoms, usefulness, purpose, resilience and recreational physical activity. The results of this study provide support for the feasibility of the VIP Program. Further study is necessary to examine efficacy.

The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease is the leading cause of death and major disability in adults ≥75 years of age; however, despite the large impact of cardiovascular disease on quality of life, morbidity, and mortality in older adults, patients aged ≥75 years have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older patients with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in a nursing home or assisted living facility. As a result, current guidelines are unable to provide evidence-based recommendations for diagnosis and treatment of older patients typical of those encountered in routine clinical practice. The objectives of this scientific statement are to summarize current guideline recommendations as they apply to older adults, identify critical gaps in knowledge that preclude informed evidence-based decision making, and recommend future research to close existing knowledge gaps. To achieve these objectives, we conducted a detailed review of current American College of Cardiology/American Heart Association and American Stroke Association guidelines to identify content and recommendations that explicitly targeted older patients. We found that there is a pervasive lack of evidence to guide clinical decision making in older patients with cardiovascular disease, as well as a paucity of data on the impact of diagnostic and therapeutic interventions on key outcomes that are particularly important to older patients, such as quality of life, physical function, and maintenance of independence. Accordingly, there is a critical need for a multitude of large population-based studies and clinical trials that include a broad spectrum of older patients representative of those seen in clinical practice and that incorporate relevant outcomes important to older patients in the study design. The results of these studies will provide the foundation for future evidence-based guidelines applicable to older patients, thereby enhancing patient-centered evidence-based care of older people with cardiovascular disease in the United States and around the world.

Pet ownership (PO) has been linked to better health outcomes in older adults, particularly those with chronic health conditions. It is suggested that pets influence their owners lives both by encouraging social interaction and by interfering with owners’ willingness or ability to seek care for themselves. We use data from 6 questions about the positive and negative influence of pets on community dwelling older adults’ administered to pet owners (N=223, age >=50 years) in the Baltimore Longitudinal Study of Aging. We use principal components analysis (oblique rotation) to extract dimensions of owner’s perceptions of pet influences (PPI) and examine the relationship of these dimensions to owners’ cognitive, physical functional, and psychological status. Three dimensions of PPI include: fiscal/health challenges (F1: 3 items, alpha=0.70), wellness promotion (F2: 2 items, alpha=0.80); and reason for social/travel constraints (F3: 1 item). In regression analysis with all factors entered simultaneously, after controlling for age, higher magnitude of F1 significantly independently predicted poor physical quality of life (p=.0007), greater perceived stress (p=0.041), and lower happiness (p=0.014); F2 did not independently predict any health outcome; higher F3 significantly independently predicted lower emotional vitality (p=0.048). Controlling for age, all three factors were independent predictors of pet attachment (p’s=0.001, 0.010, 0.047, respectively). F1 and F3 were positively and F2 was negatively correlated with attachment. PPI was associated with owners’ physical and mental health. Perhaps older adults with higher attachment to pets are more likely to keep them despite higher challenges.

Measuring clinical outcomes among older adults with moderate to severe dementia present practical and psychometric challenges. Proxy report surveys, direct observations, chart abstraction, and objective measures, such as actigraphy are frequently used with this population. The purpose of this paper is to describe issues related to measurement in the FBFC trial. Challenges to actigraphy included the resistance of residents and removal of devices, inability to detect limited movement and/or the type of activity performed. The combined use of the three measures to optimize understanding of physical activity will be addressed. Behavioral outcome measures included the Cornell Scale for Depression in Dementia, the Cohen Mansfield Agitation Inventory, and the Resistiveness to Care Scale. Despite the use of these multiple measures, limited behaviors were identified due to timing of assessments and items included within the measures. Optimal ways in which to capture behavioral symptoms will be reviewed.

Background: The Cohen-Mansfield Agitation Inventory (CMAI), available in both long and short versions, is a widely used measure to assess and evaluate agitation among older adults. There has been less psychometric testing of the short-form CMAI particularly with regard to the factor structure of this shorter measure. Purpose: The purpose of this study was to test the internal consistency, reliability and validity of short-form CMAI in a sample of nursing home residents and examine if it is invariant across gender. Specifically, it was hypothesized that consistent with the long form CMAI, the short-form CMAI would have three factors with acceptable internal consistency and item reliability. In addition, it was hypothesized that there would be no difference in factor structure and factor means across gender. Methods: This study utilized baseline data from a randomized trial including 553 residents from 55 nursing homes. Data was analyzed using structural equation modeling. Results: Confirmatory factory analysis supported the three-factor structure of short-form CMAI including aggressive (α= 0.794), physically non-aggressive (α= 0.617), and verbally agitated (α= 0.718) behaviors; three items loading on physically non-aggressive behaviors had R2 close to 0.3 suggesting low reliability. Invariance testing confirmed that the shortened measure is invariant across gender. Conclusions: Short-form CMAI is a valid and reliable scale to assess agitation and gender differences in agitation in nursing home population. However, it could benefit from rewording the items with low reliability or, merging them with other similar items. Future work could also consider a four-factor structure for this shortened measure.

Functional decline in older adults often lead towards acute or long-term care. In practice, caregivers often focus on completion of care tasks and of prevention of injuries from falls. This task based, safety approach inadvertently results in fewer opportunities for older adults to be actively involved in activities. Further deconditioning and functional decline are common consequences of this inactivity. To prevent or postpone these consequences Function Focused Care (FFC) was developed meaning that caregivers adapt their level of assistance to the capabilities of older adults and stimulate them to do as much as possible by themselves. FFC was first implemented in institutionalized long-term care in the US, but has spread rapidly to other settings (e.g. acute care), target groups (e.g. people with dementia) and countries (e.g. the Netherlands). During this symposium, four presenters from the US and the Netherlands talk about the impact of FFC. The first presentation is about the results of a stepped wedge cluster trial showing a tendency to improve activities of daily living and mobility. The second presentation is about a FFC training program. FFC was feasible to implement in home care and professionals experienced positive changes in knowledge, attitude, skills and support. The next presenter reports about significant improvements regarding time spent in physical activity and a decrease in resistiveness to care in a cluster randomized controlled trial among nursing home residents with dementia. The fourth speaker presents the content and first results of a training program to implement FFC in nursing homes. Nursing Care of Older Adults Interest Group Sponsored Symposium

Interventions to prevent functional decline in hospitalized persons with dementia (PWD) require objective measures of physical activity (PA). This secondary analysis described PA using MotionWatch 8 actigraphy and considered the feasibility and validity of the MotionWatch 8 in hospitalized PWD. In the first 320 PWD enrolled in the Fam-FFC study, 261 agreed to wear a MotionWatch for 24 hours within 48 hours of admission. Minutes were recorded in sedentary ( x̄ =1767.35, SD= 1327.43), low (x̄ = 202.52, SD=127.78), moderate (x̄ =7.93, SD=25.80 ), and vigorous activity ( x̄ = .85, SD=4.50). Controlling for age, gender, race and comorbidity, counts of activity were significantly associated with ADL function (t =4.3, p

Nearly 3 million older Americans with low incomes live in subsidized housing. This population has disproportionate rates of functional impairment, cognitive impairment, and nursing home admission. Patient-centered interventions are needed to improve aging in place for this population, but little is known about resident perspectives on this topic. We interviewed 58 residents aged 62 or older and 8 caregivers from 7 housing sites. We analyzed transcripts using qualitative thematic analysis. Participants reported that several factors impacted their ability to age in place. First, most participants noted the importance of physical environment, including the design and location of their apartment building. Physical accessibility and proximity to community resources facilitated aging in place, while features such as heavy doors and smoke in communal areas posed challenges. Second, most participants identified the importance of the building’s social environment; support received from other residents and on-site staff facilitated aging in place, while gossip and unpleasant residents were barriers. Third, participants noted that health issues such as arthritis limited their ability to function independently, regardless of environment. Participants emphasized the importance of physical activity for preventing functional decline, stating, “if you don’t use it, you lose it.” Older adults living in subsidized housing view their environment as central to their ability to age in place. Our findings suggest that interventions to improve aging in place in these settings must focus not only on optimizing residents’ physical function, but also on using the environment to promote resident independence and quality of life.

The purpose of this study was to test the effectiveness of the Function and Behavior Focused Care (FBFC) intervention on function, physical activity and behavioral symptoms among nursing home residents with dementia. This study was a clustered, randomized controlled trial with a repeated measures design in 12 nursing homes. The participants (N=336) were 82.6 (SD=10.1) years of age, mostly female and were moderate to severely cognitively impaired (MMSE of 7.8, SD=5.1). There were a statistically significant improvements in time spent in light, moderate and overall physical activity based on actigraphy and a decrease in resistiveness to care at 4 months among participants in the treatment group. There was no change in mood, agitation, and the use of psychotropic medications. This study provides some support for the use of the FBFC intervention to increase time spent in physical activity and decrease resistive behaviors during care among nursing home residents with dementia. Part of a symposium sponsored by Nursing Care of Older Adults Interest Group.

The world population is aging. The proportion of the population over 60 will nearly double from 12% in 2015 to 22% in 2050. Global life expectancy has more than doubled from 31 years in 1900 to 72.6 years in 2019. The need for long-term care (LTC) services is expanding with the same rapidity. A comprehensive response is needed to address the needs of older adults. Learning from health systems in other countries enables health systems to incorporate best long-term care practices to fit each country and its culture. This symposium aims to compare long-term care policies and services in Taiwan, Singapore, and the USA where significant growth in aging populations is evidenced. In 2025, the aging population will be 20% in Taiwan, 20% in Singapore and 18 % in the USA. In the case of Taiwan, it has moved from aging society status to aged society, and to super-aged society in 27 years. Such accelerated rate of aging in Taiwan is unparalleled when compared to European countries and the United States. In response to this dramatic change, Taiwan has passed long-term care legislation that expands services to care for older adults, and developed person-centered health care that integrates acute and long-term care services. Some preliminary results related to access, care and patterns of utilization will be shared in the symposium. International Comparisons of Healthy Aging Interest Group Sponsored Symposium.

Older adults with low incomes experience disproportionate rates of cognitive and functional impairment and an elevated risk for nursing home admission. Home health aides (HHAs) can help older adults to age in place by optimizing function and engaging them in routine physical activity. Despite this potential role, little is known about HHAs’ perspectives on how to facilitate aging in place for this population. We conducted 6 focus groups with 21 English-speaking and 10 Spanish-speaking HHAs working in Philadelphia and New Jersey. Transcripts were analyzed using qualitative thematic analysis. HHAs described wearing multiple hats and pushing the boundaries of their role as a HHA to provide a “comfortable and safe” environment through nursing and emotional support. Many HHAs shared that they serve as surrogate family, often spending more time in clients’ homes than family members or other healthcare providers. This unique position provides HHAs with valuable insights into clients’ changing health which allows them to detect early warning signs of clients’ functional and cognitive decline, including falls, depression, and confusion. HHAs noted several factors that worsened clients’ decline including a lack of adaptive equipment, social isolation, and limited HHA input into clients’ care plans. They also pointed to factors that facilitated clients’ aging in place, including utilization of community-based services, family support, and communication between healthcare team members. Our findings suggest that HHAs have important insights into improving aging in place for older adults with low incomes and should be incorporated into care planning and intervention delivery.

Communication and interactions are an integral part of care in long-term care settings. Resident variables, such as race and gender, shape communication and interaction between staff and residents. The Quality of Interactions Schedule (QuIS) was developed to measure the quality of verbal and nonverbal interactions among nursing staff and older adults initially for those in acute care and later used as well in a variety of long term care settings. A quantified measurement of the quality of interactions between residents and staff was created to quantify the QuIS. The purpose of this study was to describe the gender and racial differences in scored quality of interactions. Data for the present study was based on baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) implementation study. A total of 535 residents from 55 settings were included in the analyses. An analysis of covariance was conducted to determine a difference in QuIS scores between males and females while controlling for age. The second model tested for differences in QuIS scores between blacks and whites while controlling for age and gender. There was not a statistically significant difference in QuIS scores between male and female residents. There was a significant difference in QuIS scores between those who were black versus white, such that those who were black received more positive interactions from staff than those who were white. Future work should focus on a deeper examination of resident factors and staff factors that may influence these interactions.

There are many challenges to engaging long term care residents with dementia in physical and functional activities. Resident factors include age, comorbidities, cognitive impairment, motivation, sedation and polypharmacy. Facility factors include the environment, policies and culture within the setting such as a focus on safety versus function. Commonly used non-evidence based interventions include discouraging residents from walking by repeatedly telling them to sit down, and limiting recreational activities to seated positions. De-implementation to remove inaccurate care practices and implementation approaches are needed to facilitate implementation of Function and Behavior Focused Care. This paper will describe the use of the Synthesis Model for the Process of De-Adoption and the Evidence Integration Triangle implementation strategy in the development of the Function and Behavior Focused Care intervention to alter behavior among staff and cognitively impaired residents and optimize function and physical activity in long term care.

Nearly 3 million older Americans with low incomes live in subsidized housing. This population has disproportionate rates of functional impairment, cognitive impairment, and nursing home admission. Staff members who work in subsidized housing may have unique insight into how to improve aging in place for this vulnerable population, but little is known about their perspectives. We conducted 12 focus groups with 69 staff members from 7 subsidized housing sites. Staff included property managers, service coordinators, maintenance workers, administrative assistants, and security guards. Transcripts were analyzed using qualitative thematic analysis. The majority of participants noted that they “wear multiple hats” and their roles are not limited to professional responsibilities. Instead, their role is to maximize residents’ quality of life. As a result, staff members often adopt personal roles akin to serving as residents’ “surrogate family” members. This relationship gives staff a unique window into residents’ lives which enables them to detect early warning signs among residents. For example, staff often observed changes in residents’ physical appearance and hygiene, mood, behavior, and function which could indicate physical illness, mental illness, or cognitive impairment. Staff reported having some resources to address these warning signs, such as involving families and connecting residents to community resources. However, they also highlighted unmet needs to address these issues, such as on-site clinical staff and affordable mental health services. Our findings suggest that building staff are a valuable and underutilized resource for identifying at-risk residents in subsidized housing and helping to deliver interventions to improve aging in place.

GSA COVID-19 Task Force members worked with organizational leaders and special interest groups to ascertain areas where further research about COVID-19 and older adults would be helpful. The responses were compiled into a single document to create a research agenda. Processes to share the agenda with federal agencies and partners will be shared.

Background and Purpose: The purpose of this study was to test the reliability and validity for two new scales. Methods: We used baseline data from a worksite health promotion project with 98 long-term care staff and Pearson correlations and Rasch analysis testing. Results: For Staff Self-Efficacy for Function Focused Care and Staff Outcome Expectations for Function Focused Care item, reliability was .80 and .83, respectively. All items except one had acceptable INFIT and OUTFIT mean square statistics. Both new scales were significantly correlated (r = .342, p = .007), but neither of the scales were correlated with participants’ baseline exercise levels (r = .014, p = .918; r = .092, p = .454, respectively). Conclusions: There was some evidence of validity and internal consistency for both scales. Suggestions are provided to improve the measures for future use.

The first National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers was held on October 16–17, 2017, at the National Institutes of Health. In this paper, participants from the Summit Session on Research on Care Needs and Supportive Approaches for Persons with Dementia summarize the state of the science, identify gaps in knowledge, and offer recommendations to improve science and practice in long-term care. Recommendations cover 4 areas focused on persons living with dementia: (1) symptoms (behavioral and psychological symptoms of dementia, function, cognition, and sleep); (2) dementia care settings (physical and social environments, home, and residential care); (3) living with dementia (living well with dementia, living alone with dementia, and living with dementia and intellectual and developmental disabilities); and (4) technology as a cross-cutting theme. The participants identify 10 of the most pressing research issues based on the findings from their collective papers. Final Summit recommendations included those presented by session participants and will be used to advise federal agencies and other organizations that fund research.

The current rate of immunizations for older adults does not meet the immunization goals for Healthy People 2020. Using a Social Ecological Model and Social Cognitive Theory, the purpose of this study was to disseminate and implement the Immunization Champions, Advocates and Mentors Program (ICAMP) into a variety of health care settings. This study used a single group pre-/post-test design. Champions were recruited nationally. Five geographically diverse face-to-face meetings were held to train health care providers to be ICAMP immunization champions. Dissemination and implementation of ICAMP was evaluated using the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model. Participants were surveyed at baseline for descriptive information and were asked to gather immunization rates for at least one particular vaccine and provide follow-up data on progress toward goal achievement. A total of 212 champions from 82 settings participated in ICAMP. The majority were nurses (111/212, 52%). With regard to reach, we obtained 212 applications from individuals in a variety of settings interested in becoming champions. With regard to effectiveness, the majority of the champions (n = 178/212, 84%) used ICAMP material, 88% (n = 186/212) made changes related to immunization processes within their setting, and all reported that immunization practices improved. The majority used the toolkit materials up through 60 days following ICAMP. Sustained use of materials after the 60-day follow-up was less evident. ICAMP was implemented as intended and was effective in changing processes around immunizations. Ongoing work is needed to determine whether ICAMP improves immunization rates.

Treatment fidelity was evaluated in the FBFC-CI trial based on delivery, receipt and enactment. Evidence of delivery was noted based on completion of Component I, evaluation of environments and policies; Component II, education of nurses; and Component III, motivational techniques (completion of goal forms for residents and use of self-efficacy based interventions). There was evidence of delivery of the intervention as 583 staff were educated (80% of all staff), environment and policy assessments were completed and motivation provided. Evidence of receipt was based on a mean test score after education of 9.79 (98% correct, SD=.56) and evidence of improvement in environments [baseline 13.5 (SD=2.07) increased to 15.12(.99)] and policies [8.50(SD=3.85) increased to 10.87(SD=2.41)] that facilitate function and physical activity. Evidence of enactment was based on direct observation of staff indicating that the staff provided more function focused care for residents over the course of the 12 month study period study.

Neuropsychiatric symptoms, such as delusions, hallucinations, depression, aggression, and agitation occur in two-thirds of nursing home residents with dementia. These behavioral symptoms are most likely to occur during personal care interactions and challenge and frustrate caregivers. Pharmacologic management of behavioral symptoms among residents with dementia has been minimally effective and is fraught with significant risks, such as, falls, fractures, delirium, parkinsonism, stroke, pneumonia, and death. FBFC-CI is a behavioral intervention focused on optimizing function and physical activity of residents with dementia during all care interactions. Residents in settings in which FBFC-CI was implemented had a decrease in resistiveness to care and a decrease in use of antipsychotics at four months post implementation of the intervention. There was no change in mood, agitation, use of antidepressants, anxiolytics or mood stabilizing medications. Importantly, there was no evidence that engaging residents with dementia in function and physical activity exacerbated behavioral symptoms.

The EIT-4-BPSD incorporates a focus on the assessment and alteration of the environment and policies to assure use of behavioral interventions. The purpose of this study was to test the reliability and validity of The Environment and Policy Assessments in 14 nursing homes. Based on Rasch analysis there was evidence of internal consistency for the Environment Assessment (alpha coefficient of .70) and the Policy Assessment (alpha coefficient of .81). Inter-rater reliability was .58 for the Environment Assessment and .45 for the Policy Assessment. Based on Rasch analysis there was evidence of item fit and construct validity of both measures and a good spread of the items across the full continuum of both concepts. Clarification of definitions of some items is needed to improve reliability. The measures are useful for helping settings assure that the environment and policies support the use of person centered behavioral interventions for BPSD.

Residents with cognitive impairment are at risk for functional decline and decreased physical activity once they enter nursing homes. Contributors to this decline include cognitive status, age, multiple comorbidities, pain, behavioral symptoms (depression, apathy and aggression) and environmental factors (tethering patients with restraints, the use of alarms, restrictive positioning, limited space and unsafe areas). Twelve settings were randomized to FBFC-CI or education-only and 336 residents included. The residents were 82 (SD=10) years of age, mostly female (n=242,72%), and white (n= 199, 59%) with a mean Mini Mental State Exam score of 7.8 (SD=5.06). Exposure to FBFC-CI resulted in increased time in physical activity based on actigraphy and subjective reporting of activity. There was no change in function or chair rise. Increasing physical activity via exposure to FBFC-CI has the potential to help with overall health status and quality of life of residents with dementia.

The Medicare Annual Wellness Visit (AWV) was introduced in 2011 as part of the Medicare Part B expansion under the Affordable Care Act. The AWV was promoted to encourage preventive care and mitigate health risks in aging patients through required age- appropriate and risk modifying screenings and assessments. It does not include a comprehensive physical exam. Rather it incorporates vital signs such as height, weight and blood pressure, assessments of cognition, mood, current immunization status, cancer screenings, and advanced directives. Unfortunately, the implementation of the AWV has been relatively low nationally; further, little is known about the benefits of the AWV from a patient quality of life perspective, impact on health status or cost benefits. While the AWV provides a critical opportunity to reduce risks for diabetes and hyperlipidemia, for example, through physical activity and dietary counseling, and the detection of cancer, there is insufficient provider team assessment and followup to facilitate either near-or longer-term behavior change. Moreover, little is being done to apply the findings from the AWV to facilitate behavior change through physical activity and dietary counseling, to follow-up on positive findings from cancer screening, or to reduce falls. The purposes of this symposium are to: provide a comprehensive review of the AWV; describe implementation of the AWV in a real-life setting; summarize AWV cognitive assessments; address the cost implications of the AWV; and discuss health disparities with regard to the AWV and opportunities for implementing behavior change through the AWV across a broad range of older adults.

Residents in assisted living engage in limited amounts of physical activity and decline functionally more rapidly than their peers in nursing homes. To address this functional decline and increased time in sedentary activity a dissemination and implementation approach was used to help nursing staff integrate focused care (FFC) into routine care. Twenty-six settings across Maryland, Pennsylvania, and Massachusetts were recruited into the first cohort. A total of 274 direct care workers were exposed to education about FFC and overall they scored 87% on the FFC Knowledge Test. Direct observations using the FFC Behavior Checklist for Direct Care Workers showed that FFC was provided in 10.55 (SD=3.81) out of 19 activities and was not performed in a mean of 3.01 (SD=3.03) activities observed. FFC was least likely to be encouraged during wheelchair mobility, lower extremity bathing, range of motion activities and bladder training/toileting and should be the focus of future interventions.

Residents in Assisted Living (AL) engage in limited amounts of physical activity and decline functionally more rapidly than their peers in nursing homes. Reasons for decline include resident factors (e.g., comorbidities, age) and setting factors (e.g., caregivers, environments and policies), among others. Residents and families expect that direct care workers will complete necessary care tasks and often become distressed if direct care workers just provide encouragement, cueing or minimal assistance needed to assure that residents walk, dress and bathe at their highest level. Once residents are not allowed or encouraged to perform an activity, they lose the ability and motivation to do so. Implementing a function focused care approach is the best way to prevent functional decline and increased time residents spend in sedentary activity. Function focused care is a philosophy of care that teaches direct care workers to evaluate older adults’ underlying capability with regard to function and physical activity and optimize their participation in all activities. Careful consideration has to be given to measurement of outcomes related to implementation of Function Focused Care to determine if this approach has been integrated into routine care within the setting. This symposium will address the best ways to evaluate physical activity of residents, Service Plans for evidence of function focused care, and environment and policies within these settings. Accurate measurement of these outcomes will help to assure that we are providing care to residents that will optimize function and physical activity and help them to age in place.

Significance: TTs are approved by use for patients with cancer by demonstrating efficacy in prolonging survival, improving quality of life, or both. However, little is known about older adults who take TT for cancer, including factors that influence whether or not they receive these medications. Objective: Describe sociodemographic and clinical profiles of patients aged ≥85 years who receive TTs. Specifically, we hypothesized that worse performance status and female gender would be associated with taking multiple TTs for cancer. Methods: This was a secondary analysis of a study that retrospectively examined electronic medical records for patients ≥85 years taking TT. Sociodemographic information and clinical information, performance status, and TT use were collected. Descriptive statistics were computed to describe the data distributions and to characterize the study sample. We used the χ2 test of independence to compare patients who received one TT for one cancer versus those who received multiple TTs for once on select study variables. Results: The mean age of the participants was 85 and more than half (55.6%) were female. When comparing patients who took one TT (n = 200) with those who took multiple TTs (n = 95), we found significant differences in gender (p = .027), marital status (p = .042), performance status (p = .017), and tumor mutational testing (p = .003). Conclusions: We found sociodemographic and clinical differences between the two groups of patients in our sample, suggesting that further exploration of potential predictors of TT use and persistence is needed in patients ≥85 years.

The Annual Wellness Visit (AWV) includes a health risk assessment and customized wellness or personal prevention plan for Medicare beneficiaries. Within a Continuing Care Retirement Community, AWVs are done during the birthday month of the resident and include basic assessments, cognitive screening, the PHQ-2, review of smoking, alcohol use, driving status, a functional assessment, review of medications, physical activity, screening for cardiovascular risks, cancer screenings, medications and advanced directives. Behavior change interventions are implemented using social cognitive theory. Outcomes associated with AWV include 100% adherence to completion of advanced directives, decreased number of inappropriate cancer screenings, increased physical activity, and increased management of mental health issues. The AWV allows for a focused review of critically important health issues for older adults prior to an acute event occurring such as a motor vehicle accident or an acute delirium and ideally can help to decrease the time spent disabled among older adults.