Pamela E. Toto

Goal Attainment Scaling (GAS) in geriatric primary care: A feasibility study

OBJECTIVE Evaluate the feasibility of generating patient-centered goals using GAS with older adults who have multiple chronic conditions, recruited through primary care. METHOD Adults age 65+ (N=27) were recruited from a geriatric primary care center. Participants were asked to identify 2-4 activity-based goals and set attainment levels using GAS. At 8 weeks, participants were asked to rate current level of their goal performance. Physician surveys were used to evaluate if goals were realistic and feasible, and patient surveys were implemented to evaluate satisfaction. GAS T-scores were used to quantify change in goal achievement. RESULTS Ninety-three percent (n=25) of participants were able to establish a minimum of two goals using GAS. 100% of participants were able to rate goal performance at follow-up. Physician survey results identified 100% of goals realistic and 93% achievable and 100% of participants were either neutral or satisfied with the process. Significant improvement was reported in GAS change scores (t(24)=6.54, p<0.001). CONCLUSION Findings support the feasibility of GAS for older adults with multiple chronic conditions in geriatric primary care as a strategy to facilitate patient-centered care and suggest that the process of personalized goal-setting itself may facilitate goal attainment.

Performance-Based Impairment Measures as Predictors of Early-Stage Activity Limitations in Community-Dwelling Older Adults.

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

Feasibility of Integrating Occupational Therapy Into a Care Coordination Program for Aging in Place

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

Best Practice Physical Activity Programs for Older Adults and ADL/IADL Performance: A Scoping Review

Best practice physical activity guidelines for older adults recommend multicomponent physical activity programs that incorporate behavioral change strategies and a safe design. This review examined research implementing best practice interventions and their impact on activities of daily living (ADL) and instrumental activities of daily living (IADL) for community-dwelling older adults. Of the 15 studies identified, all reported gains in at least 1 outcome, but few incorporated all features of best practice. Only 1 study evaluated ADL/IADL performance. More research implementing best practice physical activity guidelines and targeting ADL/IADL performance is indicated to understand the impact of such programs on everyday living.

The feasibility of an automatic prompting system in assisting people with traumatic brain injury in cooking tasks

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

Comparison of Two Prompting Methods in Guiding People with Traumatic Brain Injury in Cooking Tasks

This study aims to examine the effectiveness of two prompting methods (i.e., a paper-based method vs a step-by-step user-controlled method on an iPad mini) in guiding individuals with traumatic brain injury (TBI) through the cooking tasks. Eight individuals with traumatic brain injury participated in this study. They were asked to prepare two meals in their home kitchens following the guidance of the two methods, respectively. Their performance were evaluated using the Performance Assessment of Self-Care Skills (PASS) tool. The perceived ease-of-use, usefulness, and cognitive loads of the two prompting methods were assessed using a custom questionnaire. In addition, problems of participants in completing the cooking tasks with both prompting methods were categorized. Results showed that four participants completed cooking tasks more independently with the user-controlled prompting method and most participants preferred the user-controlled method to paper-based prompting. Recommendations for future development of prompting methods were also discussed.