Karina D. Ramirez

Primary Care Based Intervention to Reduce At-Risk Drinking in Older Adults: A Randomized Controlled Trial

AIMS To examine whether a multi-faceted intervention among older at-risk drinking primary care patients reduced at-risk drinking and alcohol consumption at 3 and 12 months. DESIGN Randomized controlled trial. SETTING Three primary care sites in southern California. PARTICIPANTS Six hundred and thirty-one adults aged ≥ 55 years who were at-risk drinkers identified by the Comorbidity Alcohol Risk Evaluation Tool (CARET) were assigned randomly between October 2004 and April 2007 during an office visit to receive a booklet on healthy behaviors or an intervention including a personalized report, booklet on alcohol and aging, drinking diary, advice from the primary care provider and telephone counseling from a health educator at 2, 4 and 8 weeks. MEASUREMENTS The primary outcome was the proportion of participants meeting at-risk criteria, and secondary outcomes were number of drinks in past 7 days, heavy drinking (four or more drinks in a day) in the past 7 days and risk score. FINDINGS At 3 months, relative to controls, fewer intervention group participants were at-risk drinkers [odds ratio (OR) 0.41; 95% confidence interval (CI) 0.22-0.75]; they reported drinking fewer drinks in the past 7 days [rate ratio (RR) 0.79; 95% CI 0.70-0.90], less heavy drinking (OR 0.46; 95% CI 0.22-0.99) and had lower risk scores (RR 0.77 95% CI 0.63-0.94). At 12 months, only the difference in number of drinks remained statistically significant (RR 0.87; 95% CI 0.76-0.99). CONCLUSIONS A multi-faceted intervention among older at-risk drinkers in primary care does not reduce the proportions of at-risk or heavy drinkers, but does reduce amount of drinking at 12 months.

Effect of Nurse Practitioner Comanagement on the Care of Geriatric Conditions

To determine whether community‐based primary care physician (PCP)–nurse practitioner (NP) comanagement implementing the Assessing Care of Vulnerable Elders (ACOVE)‐2 model: (case finding, delegation of data collection, structured visit notes, physician and patient education, and linkage to community resources) can improve the quality of care for geriatric conditions.

Why Do Older Unhealthy Drinkers Decide to Make Changes or Not in Their Alcohol Consumption? Data from the Healthy Living as You Age Study

To understand characteristics of older at‐risk drinkers and reasons why they decide to change or maintain their alcohol consumption.

Testing the initial efficacy of a mailed screening and brief feedback intervention to reduce at-risk drinking in middle-aged and older adults: the comorbidity alcohol risk evaluation study.

To determine the initial efficacy of a mailed screening and brief intervention to reduce at‐risk drinking in persons aged 50 and older.

Effect of a Falls Quality Improvement Program on Serious Fall‐Related Injuries

To determine whether a program that improves the quality of care for falls reduces the number of episodes of care for serious fall‐related injuries.

Patient and caregiver goals for dementia care

AbstractPurposeMost health outcome measures for chronic diseases do not incorporate specific health goals of patients and caregivers. To elicit patient-centered goals for dementia care, we conducted a qualitative study using focus groups of people with early-stage dementia and dementia caregivers.MethodsWe conducted 5 focus groups with 43 participants (7 with early-stage dementia and 36 caregivers); 15 participants were Spanish-speaking. Verbatim transcriptions were independently analyzed line-by-line by two coders using both deductive and inductive approaches. Coded texts were grouped into domains and developed into a goal inventory for dementia care.ResultsParticipants identified 41 goals for dementia care within five domains (medical care, physical quality of life, social and emotional quality of life, access to services and supports, and caregiver support). Caregiver goals included ensuring the safety of the person with dementia and managing caregiving stress. Participants with early-stage dementia identified engaging in meaningful activity (e.g., work, family functions) and not being a burden on family near the end of life as important goals. Participants articulated the need to readdress goals as the disease progressed and reported challenges in goal-setting when goals differed between the person with dementia and the caregiver (e.g., patient safety vs. living independently at home). While goals were similar among English- and Spanish-speaking participants, Spanish-speaking participants emphasized the need to improve community education about dementia.ConclusionsPatient- and caregiver-identified goals for care are different than commonly measured health outcomes for dementia. Future work should incorporate patient-centered goals into clinical settings and assess their usefulness for dementia care.

Development and Preliminary Testing of a Promotora - Delivered, Spanish Language, Counseling Intervention for Heavy Drinking among Male, Latino Day Laborers

This study developed and then tested the feasibility, acceptability and initial efficacy of a 3-session, culturally adapted, intervention combining motivational enhancement therapy (MET) and strengths-based case management (SBCM) delivered by promotoras in Spanish to reduce heavy drinking among male, Latino day laborers. A pilot two-group randomized trial (N=29) was conducted to evaluate the initial efficacy of MET/SBCM compared to brief feedback (BF). Alcohol-related measures were assessed at 6, 12 and 18weeks after baseline. Most intervention group participants (12/14) attended all counseling sessions and most participants (25/29) remained in the study at 18weeks. Alcohol related measures improved in both groups over time with no statistically significant differences observed at any of the time points. However the comparative effect size of MET/SBCM on weekly drinking was in the large range at 6-weeks and in the moderate range at 12-weeks. Post hoc analyses identified a statistically significant reduction in number of drinks over time for participants in the intervention group but not for control group participants. Despite the extreme vulnerability of the population, most participants completed all sessions of MET/SBCM and reported high satisfaction with the intervention. We feel our community partnership facilitated these successes. Additional studies of community-partnered and culturally adapted interventions are needed to reduce heavy drinking among the growing population of Latinos in the U.S.

Personalized Goal Attainment in Dementia Care: Measuring What Persons with Dementia and Their Caregivers Want: Personalized Goal Attainment in Dementia Care

To develop a process of goal‐setting and measurement of goal attainment in a dementia care management program.

THE EFFECTS OF AN INTENSIVE DEMENTIA CAREGIVER TRAINING COURSE ON CAREGIVER KNOWLEDGE AND PERCEIVED COMPETENCE

dementia related genes on both familial and sporadic AD patients. Methods:First, we conducted a targeted sequencing among 75 FAD index case with a gene panel of 112 genes. After collapsing rare coding variants (minor allele frequency 1%) of the GWAS loci, we genotyped them in an independent group of 487 AD case and 463 age, ancestry matched controls. Results: As a result, we detected three novel mutations in PSEN1, PSEN2, and PLD3 genes. The rs74642146 in SORL1 gene, and a missense mutation in ABCA7 gene were highly significant in sporadic AD cases, and the rs200820365 in TREM2 is significant in AD families compared with the control group. Conclusions: We conclude that rare coding variants in TREM2, SORL1 and ABCA7 are strong risk factors for AD. Target sequencing of AD-related genes is an efficient way to find novel causative and risk variants.

WEB-BASED CAREGIVER RESOURCE PORTAL: THE UCLA IMPROVING CAREGIVING FOR DEMENTIA (I-CARED) PROGRAM

To create ‘dementia-friendly’environment, some set of the mural with elderly familiar were painted on the walls of the village. And we operated an 8-seesion cognitive enhancing program composed of dementia preventing physical exercises and brain activities such as cup stacking, solving puzzles, making handicraft, and so on. The effectiveness of this project was evaluated as the changes in dementia awareness, cognitive function, and depressive symptoms. We also evaluated the satisfaction index of this project. The collected data were analyzed viaMicrosoft Excel 2010.Results: We designated the So-Su village located in Buan-gun, Jeollabuk-do as a rural ‘dementia-friendly’ village. This project was carried out with a total of 24 people living in this community from August to November in 2016. The awareness of dementia in score showed no significant difference. MMSE-DS was higher in score from 22.666.9 to 24.565.6 after the project than before (p<0.01). Geriatric Depression Scale(GDS) score was significantly higher from 4.864.6 to 4.164.4 (p<0.05). Ninety-one percent of community members were satisfied with this project. Conclusions: Jeollabukdo Provincial Dementia Center designated a rural ‘dementia-friendly’ village and carried out a pilot study of the project. This project led to improving the cognitive function and decreasing depressive symptoms among residents. Satisfaction index of this project was high, 91%. But the improvement of dementia awareness was not achieved. It is thought that a more direct and experiencing education to PWD is needed to improve awareness of dementia in order to establish the ‘dementia-friendly’ communities.