Although dementia prevention is a global priority, few interventions have been successfully translated into public health and community settings. This study evaluated the effectiveness of a nudge-based communication strategy to promote Alzheimer's disease (AD) prevention on behavioral, cognitive, and provider-level outcomes in a real-world setting.
We conducted a pragmatic cluster-randomized trial across seven senior centers. Eligible participants were adults aged ≥ 60 with cognitive impairment but no dementia. Centers were randomized to intervention (n = 3) or control (n = 4) arms. All centers offered standard activities and provider training in dementia management. The intervention arm additionally received CULTIVAMENTE, a low-intensity, nudge-based communication strategy involving posters, brochures, and web-based content promoting AD prevention. Main outcomes included changes in a composite cognitive healthy behavior score, cognitive performance (memory and executive function), prevalence of mild-to-moderate cognitive impairment, and provider practices (AD prevention discussions and referrals). Analyses used intention-to-treat linear mixed models.
Among 211 participants (mean age 74.8 ± 7.0 years; 80.5% women), after 6 months, those in the intervention group (n = 101) demonstrated greater improvement in cognitive healthy behaviors compared to control (SD difference = 0.15; 95% CI = 0.02–0.28; p = 0.021; 95.4% greater increase than control). Cognitive scores improved significantly in the intervention group (memory = 0.24; 95% CI = 0.07–0.41; memory–executive functioning = 0.21; 95% CI = 0.08–0.33), and mild-to-moderate cognitive impairment cases declined in the intervention group (from 70 to 67) compared to the control group (from 71 to 75; p < 0.001). Additionally, intervention participants were more likely to report increases in knowing how to prevent AD, having discussions about ways to prevent AD with providers, and receiving referrals to manage risk factors.
Embedding nudge-based messaging into senior centers improved dementia prevention behaviors, cognitive outcomes, and provider practices. These results support testing low-cost, scalable strategies in real-world settings to reduce dementia risk.
Black family caregivers of older adults living with dementia are at high risk for physical, spiritual, and psychosocial challenges. Culturally responsive interventions are needed to address disparities in this population. Peer mentorship may improve caregiving support for Black caregivers. The purpose of this National Institute on Aging Stage Model 1A study was to test the feasibility, acceptability, and fidelity of the Peer Support for Black Family Caregivers of Persons Living with Dementia (Pair 2 Care) intervention.
Pair 2 Care is a culturally responsive, non-judgmental, flexible, co-designed virtual peer support intervention in which former caregivers are paired as peer mentors with current caregivers for 6 months. We enrolled 11 former caregivers (mentors) and 15 current caregivers (mentees) for a total of 15 mentor–mentee pairs. Four mentors were double-paired while maintaining 1:1 mentor–mentee relationships. Mentors' and mentees' activities were monitored using surveys to ensure they were carried out as designed. Feasibility and acceptability were measured by evaluating inclusion and exclusion outcomes, recruitment, and retention data, satisfaction, and appropriateness of Pair 2 Care.
All mentors and mentees were female and mostly daughters (65%) who currently or previously cared for an older adult parent who lived with dementia. Pair 2 Care was highly feasible and acceptable based on participant enrollment, mentor training completion, and mentee–mentor pairing within 10 weeks. Former caregiver mentors were retained at 90% and mentees at 93% over 6 months. On average, participants rated their overall Pair 2 Care satisfaction as very high (4.6/5).
Pair 2 Care may provide an innovative strategy to improve family caregiver health outcomes such as quality of life among Black caregivers of Black people living with dementia to promote health equity. As a next step, a fully powered trial is needed to determine Pair 2 Care intervention efficacy.
Trial Registration: ClinicalTrials.gov: USGOV NCT06064955
While the immediate effect of exposure to severe weather from hurricanes on mortality is well documented, it is unknown whether mortality in the year following exposure to severe weather differs across older Americans with specific vulnerable characteristics. This paper sought to determine whether the association between exposure to high rain and one-year mortality differs across vulnerable subgroups of older adults.
This retrospective cohort study used Medicare claims data from fee-for-service beneficiaries aged ≥ 65 in Texas and Louisiana in the year before and after Hurricane Harvey. Historical weather data was used to construct a 4-day measure of cumulative rainfall, the primary severe weather caused by Hurricane Harvey. We identified vulnerable subgroups based on five chronic health conditions requiring regular healthcare access, and sociodemographic factors (e.g., ≥ 85 years, dual eligibility). Cox proportional hazards regression was used to adjust for covariates when estimating the association between high rain exposure and mortality up to 1 year after exposure.
In adjusted models, high rain exposure was significantly associated with greater mortality risk (HR 1.03, 95% CI 1.01–1.05). Among those with chronic health conditions including Alzheimer's disease and related dementias (ADRD) (HR 1.05 [95% CI 1.03, 1.08]), diabetes (HR 1.04 [1.02, 1.07]), and chronic kidney disease (HR 1.04 [1.01, 1.06]) exposed to high rain versus those unexposed to high rain, associations with high rain were found. Higher mortality was also observed among Non-Hispanic Black (HR 1.06 [95% CI 1.01, 1.11]) and Hispanic and Latino populations (HR 1.13 [95% CI 1.08, 1.19]).
Exposure to high rain from Hurricane Harvey was associated with higher one-year mortality that varied across vulnerable groups. The largest associations were observed among older adults with health conditions that require regular healthcare (e.g., CKD, ADRD) and minoritized racial and ethnic groups.
Older adult patients with dementia experience higher rates of traumatic injury, yet little is known about long-term recovery trajectories in this population. This multi-center retrospective cohort study examined differences in long-term patient-reported outcomes after traumatic injury in older adults with and without dementia.
Secondary analysis of trauma patients ≥ 65 years with moderate or severe trauma (Injury Severity Score > 9) admitted to three Level I trauma centers and interviewed 6–12 months post-injury. Primary outcomes were loss of community living and activities of daily living (ADL) impairment. Multivariable logistic and linear regression adjusted for age, sex, educational level, and injury mechanism.
Among 3210 older adult trauma patients, 291 (9.1%) had dementia before injury. Dementia patients presented with similar injury severity compared to those without dementia (mean ISS 12.1 (5.7) vs. 12.8 (6.2), p = 0.076); however, they had a greater number of new ADL limitations post-injury (1.86 (2.07) vs. 1.0 (1.55), p < 0.001). Among patients living at home pre-injury, 16.5% with dementia were discharged to institutionalized settings, compared to 4.9% without dementia (p = 0.185). Older women with dementia had significantly higher odds of losing community living status compared to older women without dementia (OR = 2.12 [1.17, 3.84], p = 0.013).
Older adults with dementia who sustain traumatic injuries face a substantial risk of functional deterioration and loss of independence in the critical 6–12 months post-injury. These findings highlight the need for interventions aimed at preserving autonomy and minimizing premature transitions to long-term care.
Research has revealed dementia disparities among underserved older adults. Built upon standard-Reducing Disability in Alzheimer's Disease (s-RDAD), Innovations in Dementia Empowerment and Action (IDEA) is designed and culturally tailored for underserved communities through an empowerment stigma-reduction cognitive-behavioral intervention and tested with sexual and gender minority (SGM) adults and care partners.
The study is a 2-arm (IDEA and s-RDAD), single-blind, randomized controlled trial (RCT) with a staggered multiple baseline design. With 161 dyads (person living with dementia/care partner), the aim of the study is to compare the two arms via between and within group differences on primary (physical activity) and secondary outcomes (e.g., quality of life, physical functioning, and resource literacy) at post-treatment, and 30 and 56 week follow-up.
When comparing the two arm between-group differences, the IDEA care partners' community resource literacy was significantly higher at 30-week follow-up than for s-RDAD (contrast = 0.10, p = 0.005). While both intervention arms demonstrated efficacy with significant improvement in physical activity (contrastIDEA = 0.10, p = 0.010; contrasts-RDAD = 0.14, p < 0.001) and quality of life (contrastIDEA = 0.06, p < 0.001; contrasts-RDAD = 0.03, p = 0.035) for the person with dementia at post-treatment, positive treatment effects on physical activity (contrastIDEA = 0.09, p = 0.032) and quality of life (contrastIDEA = 0.03, p = 0.040) persisted at 30 weeks for IDEA but not for s-RDAD.
While both intervention arms were efficacious, IDEA demonstrated sustained efficacy. The cultural tailoring of interventions is promising to address disparities in dementia care and interventions in underserved communities. Future research is needed for the translation of this efficacious intervention to the larger community.
Clinicaltrials.gov identifier: NCT03550131
The Perioperative Optimization of Senior Health (POSH) clinic was established to address vulnerabilities and improve outcomes in frail older patients. This study describes the results of comprehensive perioperative optimization by the POSH interdisciplinary team (IDT) in patients who underwent colorectal surgery.
Frail patients planned for colorectal surgery and enrolled in the POSH clinic (10/2021–09/2023) were retrospectively identified. Descriptive statistics were used to summarize the findings of preoperative geriatric assessment and postoperative outcomes. Outcomes were compared with a contemporary propensity-matched cohort using chi-squared analysis and two-sample t-tests for categorical and continuous variables, respectively.
Thirty-six patients with a median age of 80 years and a mean Charlson Comorbidity Index of 6.11 were planned for colorectal surgeries, most commonly colectomy (62.1%) and ostomy reversal (20.7%). Twenty-nine patients underwent surgical management after interdisciplinary optimization in the POSH clinic. The most common interventions recommended included advance care planning (86.2%), physical therapy (55.2%), and medication management (34.5%). Postoperatively, 75% of patients were discharged home, and there were no mortalities within 90 days. There were no significant differences in postoperative outcomes when compared to a contemporary propensity-matched cohort. The remaining seven patients enrolled in POSH did not undergo surgical management after surgery was deemed inconsistent with their goals of care, and three of these patients expired within 1 year of evaluation in POSH.
The POSH model provides high-risk patients with individualized risk stratification, comprehensive interdisciplinary strategies for risk mitigation, and alignment of care with patient goals. When elective colorectal surgery was within their goals of care, frail older adults safely underwent operative intervention after careful perioperative optimization. Future studies should include a mixed-method exploration of the patient perspective and a randomized controlled trial to quantify the impact of the POSH clinic on short- and long-term postoperative outcomes.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：