Sarah D. Holmes

Automated Functional and Behavioral Health Assessment of Older Adults with Dementia

Dementia is a clinical syndrome of cognitive deficits that involves both memory and functional impairments. While disruptions in cognition is a striking feature of dementia, it is also closely coupled with changes in functional and behavioral health of older adults. In this paper, we investigate the challenges of improving the automatic assessment of dementia, by better exploiting the emerging physiological sensors in conjunction with ambient sensors in a real field environment with IRB approval. We hypothesize that the cognitive health of older individuals can be estimated by tracking their daily activities and mental arousal states. We employ signal processing on wearable sensor data streams (e.g., Electrodermal Activity (EDA), Photoplethysmogram (PPG), accelerometer (ACC)) and machine learning algorithms to assess cognitive impairments and its correlation with functional health decline. To validate our approach, we quantify the score of machine learning, survey and observation based Activities of Daily Living (ADLs) and signal processing based mental arousal state, respectively for functional and behavioral health measures among 17 older adults living in a continuing care retirement community in Baltimore. We compare clinically observed scores with technology guided automated scores using both machine learning and statistical techniques.

Factors that Influence Physical Activity among Residents in Assisted Living

ABSTRACT The purpose of this study was to examine factors that influence physical activity among residents in assisted living. This was a secondary data analysis using baseline data from a function-focused care intervention study including 171 residents from 4 assisted living facilities. Using structural equation modeling, we found that mood, satisfaction with staff and activities, and social support for exercise were directly associated with time spent in physical activity. Gender, cognition, depression, and comorbidities were indirectly associated with physical activity and accounted for 13% of the total variance in physical activity. Implications for future research and social work practice are presented.

Motivators for Alzheimer’s disease clinical trial participation

BackgroundAlzheimer’s disease (AD) research progress is impeded due to participant recruitment challenges. This study seeks to better understand, from the perspective of individuals engaged in clinical trials (CTs), research motivations.MethodsParticipants, or their caregivers, from AD treatment and prevention CTs were surveyed about research motivators.ResultsThe 87 respondents had a mean age of 72.2, were predominantly Caucasian, 55.2% were male, and 56.3% had cognitive impairment. An overwhelming majority rated the potential to help themselves or a loved one and the potential to help others in the future as important motivators. Relatively few respondents were motivated by free healthcare, monetary rewards, or to make others happy.ConclusionsRecruitment efforts should focus on the potential benefit for the individual, their loved ones, and others in the future rather than free healthcare or monetary rewards.

Physical Activity and Function in Assisted Living Residents

The purpose of this study was to consider the feasibility, reliability, and validity of MotionWatch 8. A total of 249 residents were recruited from 26 assisted living settings. Data collection included demographics, comorbidities, function (Barthel Index), physical activity (MotionWatch 8), and falls. The mean age of participants was 86.86 (SD = 7.0), the majority were women 179 (74%) and White (N = 232, 96%). A total of 86% of participants wore the MotionWatch 8. There were no significant differences in physical activity over 3 days of testing. The MotionWatch 8 findings were significantly associated with activities of daily living (ADL) function. There were no significant differences in ADL function or physical activity between those who did and did not fall. The study provides additional support for the feasibility, reliability, and validity of the MotionWatch 8 and confirms that older adults living in assisted living settings spend the majority of their time in sedentary activity.

Electrophysiological repetition effects in persons with mild cognitive impairment depend upon working memory demand

ABSTRACT Forms of implicit memory, including repetition effects, are preserved relative to explicit memory in clinical Alzheimers disease. Consequently, cognitive interventions for persons with Alzheimers disease have been developed that leverage this fact. However, despite the clinical robustness of behavioral repetition effects, altered neural mechanisms of repetition effects are studied as biomarkers of both clinical Alzheimers disease and pre‐morbid Alzheimers changes in the brain. We hypothesized that the clinical preservation of behavioral repetition effects results in part from concurrent operation of discrete memory systems. We developed two experiments that included probes of emotional repetition effects differing in that one included an embedded working memory task. We found that neural repetition effects manifested in patients with amnestic mild cognitive impairment, the earliest form of clinical Alzheimers disease, during emotional working memory tasks, but they did not manifest during the task that lacked the embedded working memory manipulation. Specifically, the working memory task evoked neural repetition effects in the P600 time‐window, but the same neural mechanism was only minimally implicated in the task without a working memory component. We also found that group differences in behavioral repetition effects were smaller in the experiment with a working memory task. We suggest that cross‐domain cognitive challenge can expose “defunct” neural capabilities of individuals with amnestic mild cognitive impairment. HighlightsPersons with MCI show repetition effects during concurrent working memory task.Persons with MCI show no repetition effects without concurrent working memory task.Discrete neural mechanisms underlie task‐dependence of neural repetition effects.

Students’ perceptions of interprofessional education in geriatrics: a qualitative analysis

ABSTRACT Interprofessional education (IPE) is critical for ensuring that students are prepared to collaborate with team members across disciplines once they enter clinical practice; particularly, in the complex care of the geriatric population. This qualitative study explored the experiences of interdisciplinary students in a clinical based IPE experience at a senior housing residence. Reflective journals were examined from students (n = 23) in nursing, social work, pharmacy, and medicine participating in an IPE program. Four core themes emerged in the analysis: exposure to geriatrics, IPE advantages for students, IPE advantages for older adults, and IPE challenges. Findings from this study confirmed advantages of IPE in a real-world clinical setting in terms of students learning the value and scope of practice of interdisciplinary team members. The exposure to geriatrics helped students to gain an in-depth understanding of issues affecting older adults in the community and increase professional confidence in their future clinical practice.

Reliability and Validity of the Checklist for Function-Focused Care in Service Plans:

The purpose of this study was to test the reliability and validity of the Checklist for Function-Focused Care in Service Plans. Function-focused care is a care approach that optimizes function and physical activity during all care interactions. This study used baseline data from the first cohort of the study titled Dissemination and Implementation of Function-Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT). A total of 242 participants were recruited from 26 assisted living facilities. The majority of participants were White, female, and unmarried. There was support for internal consistency with an alpha coefficient of .96, interrater reliability with a correlation of .80, construct validity based on Rasch analysis and INFIT statistics ranging from 0.69 to 1.29, and a significant association with function-focused care activities. Although there is some support for reliability and validity of the measure, modifications are recommended to add more challenging items.

Differences Between Moderate to Severely Cognitively Impaired Fallers Versus Nonfallers in Nursing Homes

Introduction: The purpose of this study was to test differences in psychotropic medication, function, physical activity, agitation, resistiveness to care, comorbidities, and depression among moderate to severely cognitively impaired nursing home residents who were fallers versus nonfallers. Methods: This was a secondary data analysis using baseline data from a randomized controlled trial testing the Function and Behavior Focused Care intervention across 12 nursing homes. The sample included 336 older adults, the majority of whom were female and white. Results: There was a significant difference in the total number of comorbidities, agitation, the total number of psychotropic medications, depressive symptoms, and physical activity between those who fell and those who did not fall (Pillai-Bartlett trace = 4.91; P < .001). Discussion: Findings support prior work except with regard to medication use, cognition, and function. Due to inconsistent findings, additional research is recommended particularly with regard to the use of specific drug groups and medications.