Implementation of Aging-in-Place Services for Older Adults with Alzheimer's Dementia

About This Grant

We aim to continue to longitudinally follow our current cohort study [R01AG058777] (n=293, 94.5% retention rate) to better understand how older adult aging-in-place/long term care (AIP/LTC) decision making, and implementation change over time - impacted by age-related changes (e.g., cognition, function, chronic condition), social influences (e.g., family/friend caregivers), and environmental factors. Remaining in one’s own homes is a priority for many older adults but progressively worsening cognition, seen with Alzheimer’s Dementia (AD), often necessitates support in the home or moving into LTC facilities. Older adults often do not plan for their AIP/LTC needs which leaves families/friends unprepared to handle crises or implement their loved ones’ goals. In our current grant, older adults from an NIA-funded cohort (LitCog) with extensive cognitive testing, were provided with a PCORI-funded intervention (PlanYourLifespan.org - PYL) that facilitates AIP/LTC decision making, at baseline (T0). After the initial intervention, we are following subjects every 6 months through 42 months, with surveys to examine how AIP/LTC decisions are made and implemented. Surveys assess changing subject characteristics, AIP/LTC decisions, implementation, and concordance. Thus far, significant findings have shown: 1.) Older adults require distinctive cognitive subtypes to make AIP/LTC plans (e.g., inductive reasoning, working memory) which may not be detected in conversation or routine memory screening. 2.) Instead of a linear process (pre-contemplative, contemplative, decision), AIP/LTC decision can display circular patterns over a six-month period. 3.) Both external (e.g., social support) and internal (e.g., self-efficacy) factors impact decision making but these variables fluctuate over time. What is missing from this dataset – the gap that we seek to fill – is which variables ultimately impact implementation and whether the AIP/LTC plans of older adults are concordant with the real-world implementation. For this proposal we seek to continue following cohort subjects every 6 months from 48 months to 84 months. Aims are to: 1. Examine how decision making and planning for aging-in-place longitudinally changes over time, impacted by older adults’ age-related changes (e.g., cognition, function), social influences (e.g., offspring), and environments. 2. Assess whether AIP/LTC decision making translates into implementation and goal concordance for older adults and their caregivers. 3. Examine the mediating/moderating interactions between older adult age-related changes, social influences, and environments in planning and implementation for AIP/LTC choices. We will continue to conduct follow-up interviews (every 6 months; months 48 - 84) with our older adult cohort; assessing decision-making, communication, cognition, and health status given in the previous batteries. In addition, we will interview family/friend caregivers for their understanding of the older adults plans and whether implementation of support care has occurred (e.g., adding paid caregivers, moving into memory care facility). Findings have the potential to inform health providers, health care/long term care insurers, caregivers, and older adults nationally in supporting and implementing aging-in-place decisions.