No abstract

Background Widespread lifestyle risk reduction at the community level is considered effective in decreasing Alzheimer’s disease (AD). To address the limited use of risk deduction in AD, this study aimed to explore the feasibility of community-level implementation. Diverse older adults (60+) living in Richmond, VA, with incomes below $12,000/year and managing diabetic/cardiovascular symptoms were offered weekly lifestyle telephone-health coaching for 12-weeks in 2019–2020 (Phase 1). The health coaching sessions were framed to provide AD lifestyle risk reduction education, goal setting, and support: motivations and self-efficacy. The study sample (n=40, mean age 68 years (range: 60–76 years)) was 90% African American/Black (n=36), 100% Non-Hispanic, and 45% males (n=18). Twenty-five participants (60%) reported experiencing some/often memory problems in the last 12-months. Thirty-nine (95%) of subjects successfully participated in coaching sessions; on average, 11 (91.9%) sessions per subject were completed. Participants provided positive anecdotal feedback and stated the need for continued health coaching. Consequently, n=30 (75%) of the original sample consented to continued health coaching during the 2020–2021 COVID-19 pandemic (Phase 2). All study subjects were examined at baseline (Time 1), 3-month (Time 2), covid-baseline (Time 3), and 3-months postcovid-baseline (Time 4). Repeated Measures ANOVAs were done to examine Time and Time*Memory Status effects. Results There was a total risk reduction at Phase 1 (F=9.26; p=.004; effect size=.19). At Phase 2, alcohol use decreased (p=.05), quadratic time effects were observed in physical activity (p=.01–.02), and cubic time effects were observed in depression (p=.02). Overall, total risk reduction in Phase 2 was observed at F=5.05; p=.03 effect size=.16. Pre/post-test analyses indicated improvement in Memory Problem Time Interaction (p=.007), AD knowledge (p=.01–.03), and Tired Days (p=.04) across Phase 1. There was also improvement in Social Isolation Time Interaction (p=.03); Tobacco Addiction (p=.001); Poor Mental Health Days (p=.05), and Worried Days Time Interaction (p=.02−.01) across Phase 2. Between subject Memory Status effects, indicating poorer baseline levels for individuals reporting memory problems had greater improvement seen in memory complaints (p=.001), poor mental health days (.02), and tired days (.003−.01). Conclusions This preliminary work creates the impetus for future large-scale lifestyle AD risk reduction investigations to mitigate and improve modifiable AD risk among low-income, diverse older adults, including individuals reporting memory problems. Our findings surrounding participant engagement and positive trends in AD risk reduction support the hypothesis that telephone-based health coaching is a practical and feasible AD risk reduction intervention.

No abstract

Lifestyle risk reduction at the community-level, is currently considered an effective method to decrease Alzheimer’s disease (AD). As part of the Virginia Commonwealth University iCubed Health and Wellness in Aging Core, diverse older adults (60+) in Richmond, VA, with incomes below $12,000/year and managing either diabetes/cardiovascular symptoms, were offered weekly lifestyle telephone-health coaching for 12-weeks, providing education, support, and monitoring for AD lifestyle risk in 2020-21. The study sample (n=40, mean age 68 years (range: 60-77 years) was 88% African American/Black (n=35), 100% Non-Hispanic, 45% males (n=18)), 60% reporting memory problems and 53% reporting any alcohol consumption. Thirty-nine (95%) of subjects successfully participated in coaching sessions; on average 91.9% (11) sessions were completed. Participants provided positive anecdotal feedback and the need for continued coaching during COVID. Average drinks per day decreased across the study period (F=7.44; p=.01) and alcohol risk, defined as more than 1 drink/day, decreased (F=3.46;p=.07). Drinking at baseline was associated with differential change in nicotine dependence (F=14.00 ;p=.02), depression risk (F=3.20;p=.09), light physical activity (F=4.52;p=.05), and cognition (COGTEL) (F=6.35;p=.02). Drinking between-subject effects indicated poorer level differences for smoking risk (F=5.68;p=.02), physical inactivity risk (F=4.66;p=.04), and total health behavior risk (F=14.54;p=.001), but higher cognition-scores (F=3.18;p=.11) for drinkers. In conclusion, there may be a paradoxical health effect for alcohol, with associations for negative health behaviors, but positive cognitive functioning. In conclusion, this preliminary work creates the impetus for future large-scale AD risk reduction investigations to improve the lives of AD-risk, low-income, diverse older adults reporting alcohol consumption.

Three Geriatrics Workforce Enhancement Programs (Johns Hopkins, Penn State and Virginia Commonwealth) within Health and Human Services Region-3, implemented a project providing tailored educational content designed to meet the regional needs of nursing home staff, residents, and carepartners within the context of the COVID-19 pandemic. Semi-Structured, recorded focus groups were conducted with direct care workers, and family and resident counsels. All groups were interviewed about familiarity and comfort with the 3Ds (Dementia, Delirium, and Depression) as well as what mattered most to them as workers, residents and care partners. The overall goal was to enhance development of the nursing home workforce thus creating a meaningful clinical improvement in care. We aim to go beyond the improvement of routine clinical care and address the long-standing behavioral and mental health disparities observed in this resident population. Policy implications around education, engagement of workforce, resident, and carepartner voices will be discussed.