Ruth M. Tappen - US grants

DESCRIPTION: (Adapted from investigator's abstract) Many older adults undergoing hip repair fail to return to their premorbid level of physical function. Increasingly rapid discharge from acute care and inpatient rehabilitation setting shifts more of the responsibility for continued progress toward recovery onto the patients. In self-care parlance, supportive-educational assistance is needed by these patients to manage their own care. Development of individually tailored video-based materials to support and inform the older person's efforts is proposed. A user-friendly system for nursing home-based rehabilitation and the instructions given at discharge will be set up and tested. In addition, a standard (generic) video program that documents the sequence of self- care activities from injury to recovery will be produced and given to patients to review during rehabilitation and after discharge home. Both the system and the generic video are readily marketable. To evaluate the effectiveness of the supportive-education materials, video intervention patients' physical function, self-care efficacy and mood at admission, discharge, one week and 3 months post-discharge will be compared to a non-video control group. Patients will also be asked to evaluate the usefulness of the video package.

Given the growing number of nursing home residents with Alzheimer's diseases, cost effective interventions that can reduce or delay their need for assistance with mobility and self-care activities of daily living are sorely needed. There is increasing evidence that exercise may represent such an intervention. The purpose of this study is to compare the effectiveness of 1) a comprehensive exercise program to build strength, flexibility, balance and endurance that is specifically designed for this population 2) a more commonly used supervised walking program and 3) attention control in a 3 group repeated measures experimental design with random selection and random assignment to treatment. One hundred twenty deconditioned resignets with a confirmed diagnosis of Alzheimer's disease will be selected fromt he impatient units of three nursing homes. Residents entered into the study will received treatment 5 times a week for 16 weeks. Data on their physical performance and the degree of assistance they require in mobility-related and self-care ADL's will be collected at pretest and post-test. Multivariate and univeriate repeated measures analysis of variance will be used to determine the impact of the intervention. It is hypothesized that the deconditioned nursing home residents with Alzheimer's disease who participate in the comprehensive exercise program will demonstrate greater improvement in physical performance, mobility-related activities of daily living (ADL's) and self-care ADL's than those in the walking group who, in turn, will demonstrate greater improvement than those in the attention control. A low cost intervention such as the one proposed that reduces excess disability and maintains residents at their highest possible level of function would not only increase their quality of life but also reduce the cost of their care.

DESCRIPTION (provided by applicant): The dramatically increasing numbers of African American and Hispanic American older adults raises concerns about their adequate representation in research and the appropriateness of current assessments and interventions. This is especially important for those who develop dementia with concomitant difficult expressing their thoughts and feelings. The purpose of this study is to: 1) examine existing and newly created measures of expressive language and mood for culture bias in use with older African Americans and Hispanic Americans, and 2) refine and modify those instruments that do not demonstrate adequate reliability and validity until satisfactory levels are achieved. Six hundred subjects, 100 African American, 100 Hispanic American and 100 European American older adults with dementia and equal number of normal controls, will be recruited from community and institutional sites. Data on subjects' age, gender, socioeconomic status, education, ethnic group, acculturation and mental status will be obtained. Primary raters will be matched on ethnic group; reliability of raters of same and different ethnic group will be examined using videotapes of the testing sessions. Two new instruments, the Miami Naming Test and Alzheimer's Mood Scale will be evaluated as will the well known Boston Naming Test, Animal Fluency, Lawton Observed Affect Scale, Cornell Scale for Depression in Dementia and Dementia Mood Assessment Scale. Internal consistency of each measure will be evaluated. Using generalizability theory as a framework for analysis, all measures will be evaluated for interrater reliability and stability over time. Cultural match/mismatch between subject and rater will also be evaluated on the mood scales. Ability of Miami Naming Test to discriminate cognitively impaired and unimpaired will be compared with the Boston Naming Test as will the Animal Fluency with other categories (fruit, vegetable, clothing). Likewise, ability of the new Alzheimer's Mood Scale to discriminate psychiatrically distressed from nondistressed subjects will be compared with the other mood scales. Differential item functioning analysis will guide the revisions and modifications. As outreach efforts to bring minority individuals in for assessment of memory disorders expands and research on the efficacy of treatment is conducted, the demand for culturally appropriate tests is an urgent one. Both clinicians and researchers need to know which tests are appropriate, the extent to which the ethnicity of the examiner affects the results and how to interpret the scores obtained on both the newly developed and widely used tests.

DESCRIPTION (provided by applicant): This proposal directly addresses the national imperative for innovative strategies to improve care for Medicare beneficiaries and reduce health care costs. The overall objective of the proposed project is to improve the care of older individuals who reside in nursing homes (NHs), and at the same time reduce unnecessary Medicare expenditures. This goal will be accomplished by testing a quality improvement program designed to reduce the number of avoidable hospitalizations of NH residents in a randomized controlled trial. Hospitalizations of NH residents are frequent and associated with numerous complications and increased health care costs. Previous research suggests that as many as two-thirds of such hospitalizations may be avoidable. Anticipated changes in Medicare reimbursement will reduce financial incentives that favor hospitalization, but could result in reduced care quality if NH staff does not have the training and clinical tools to manage residents in the NH when acute changes occur. INTERACT (Interventions to Reduce Acute Care Transfers) is a quality improvement program that utilizes tools based on established clinical guidelines. The tools target three key strategies to reduce potentially avoidable hospitalizations: 1) preventing conditions from becoming severe enough to require acute hospital care; 2) managing selected acute conditions in the NH; and 3) improving advance care planning for residents among whom a palliative or comfort care plan, rather than acute hospitalization, may be appropriate. Preliminary research involving 30 NHs demonstrated a 17% reduction in hospitalizations compared to the same six-month period in the previous year. The cost of the intervention was $7,700; projected savings to Medicare of reduced hospital admissions from a 100-bed NH were $125,000/year. While these results are promising, the effectiveness of INTERACT in reducing hospitalizations remains to be tested in a controlled trial. The proposed project will therefore involve an interdisciplinary team of experienced NH researchers in conducting a randomized controlled trial to test the implementation of the INTERACT program. NHs randomized to INTERACT implementation will participate in 3- months of training followed by a 12-month implementation period during which they will be supported by an experienced nurse practitioner through regular teleconference calls and as-needed telephonic or email communication. The effects of implementing the INTERACT program on hospitalization rates will be compared to a randomly assigned group of usual care control NHs and a group that will self-monitor hospitalization rates only. The hypotheses to be tested are: 1) INTERACT implementation NHs will have a greater reduction in hospitalization rate than the control and monitoring only NHs during the 12-month implementation period compared to a 12-month baseline period; and 2) reductions in Medicare expenditures for hospitalizations in the INTERACT NHs will exceed the estimated costs of implementing the program. PUBLIC HEALTH RELEVANCE: Project Narrative Strategies to improve care for Medicare beneficiaries that also reduce health care costs are critical to the health of our nation and the preservation of Medicare for future generations. The proposed project strives to help accomplish this goal by testing an innovative quality improvement program INTERACT (Interventions to Reduce Acute Care Transfers)) designed to reduce the number of avoidable hospitalizations of nursing home residents. If successful, this intervention has the potential to improve care of nursing home residents and save billions of dollars in Medicare expenditures over the next several decades.

Data science and analytics is an emerging transdisciplinary area comprising computing, statistics, and various application domains including medicine, nursing, industry and business applications among others. A significant shortcoming of the current graduate curricula in the U.S. is that scientists and engineers are well trained in their own areas of specialty but lack the integrative knowledge needed for new scientific discoveries and industry applications made possible by data science and analytics. The National Science Foundation Research Traineeship award to Florida Atlantic University (FAU) will address these shortcomings by proposing a new model of convergent education through experiential learning. Transdisciplinary education brings integration of different disciplines in a harmonious manner to construct new knowledge and uplift the student to higher domains of cognitive abilities and sustained knowledge and skills. The traineeship anticipates providing a unique and comprehensive training opportunity for approximately one hundred sixty graduate students (160), including thirty five (35) funded trainees. Thirty faculty members from five colleges and ten departments will participate in the program. The program has the potential to have a significant impact on training practices for future data science professionals.

Primary training elements of the curriculum will include the development of normalization courses, the creation of different testbeds for the various application domains, boot-camps, in-depth elective courses, and professional workshops. Normalization courses will be used to address various background of students entering the program. The convergent research themes will focus on three data science and analytics areas: (i) medical and healthcare applications, (ii) industry applications, and (iii) data science and AI technologies. To address these, the goal is to create a curriculum for graduate students in data science and analytics, where each course will be developed by at least two faculty members from two different disciplines. In order to integrate research and training, multiple testbeds for different application domains will be developed in a newly created Data Science and Artificial Intelligence Laboratory. Each testbed, which relates to a research project, will include a computer platform, software tools, and a set of learning modules. Research projects will be formulated jointly with industry partners who are members of the NSF Industry/University Cooperative Research CAKE (Center for Advanced Knowledge Enablement) at FAU. The program will produce graduates with technical depth and understanding of data science technologies and applications.

The NSF Research Traineeship (NRT) Program is designed to encourage the development and implementation of bold, new potentially transformative models for STEM graduate education training. The program is dedicated to effective training of STEM graduate students in high priority interdisciplinary or convergent research areas through comprehensive traineeship models that are innovative, evidence-based, and aligned with changing workforce and research needs.

This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.

Project Summary / Abstract Brain changes associated with Alzheimer's disease and related chronic degenerative dementias may begin as long as 20 years before clinical symptoms become evident. There is increasing evidence that unobtrusive monitoring of older adults' performance of complex daily activities of living may allow us to detect some of these subtle early changes in cognition. The rapidly increasing use of sensors not only in commercial vehicles, but also in passenger vehicles, and large number of older drivers on U.S. roads suggest that sensor data may be reconfigured to provide this early warning system. In this longitudinal mixed methods study, we will recruit and enroll 750 older drivers, establish their baseline cognitive function and driving behavior profiles, and repeat the cognitive testing and in-vehicle sensor data downloading every three months for three years (12 data points). Over this time, we expect approximately 200 participants to have experienced measurable cognitive decline either from unimpaired to mild cognitive impairment levels and/or mild cognitive impairment to early stage dementia levels. We propose to install a sensor system which will include unobtrusive cameras, on-board diagnostics (OBD), GPS and inertial measurement units (IMU) configured to track and record driver behavior in the passenger vehicles of these 750 older adult (? 65) drivers. The recorded changes in driver behavior will be compared to results from a battery of cognitive tests (global cognition, executive function, memory, visuospatial, visual attention and language) with demonstrated ability to detect early cognitive changes and to predict driver risk. The innovation of this research project lies in the rigorous testing of an unobtrusive, rapidly and readily available in-vehicle sensing and monitoring system for its ability to detect early changes in cognition in older drivers. There is an estimated 4 to 8 million older drivers with mild cognitive impairment on the roads in the U.S. This significant number of older drivers poses a major concern for public safety. Moreover, the majority may be unaware of the cognitive changes occurring. Current dementia screening programs are able to test only a small number of older adults and the wellness visits covered by Medicare do not detect these early, subtle changes. Yet early detection offers many medical, emotional and financial benefits for the individual, family and society, opening a ?window of time? to intervene in the progression of the disease in the future (Alzheimer's Association 2019 Report). The proposed testing and evaluation of a readily and rapidly available, unobtrusive in-vehicle sensing system could provide the first step toward future widespread, low-cost, early warnings of change for the large number of older drivers in the U.S.