TOWARD AN UNDERSTANDING OF BEHAVIORAL AND SENSORY EXPERIENCES WHEN LIVING WITH DEMENTIA AND RELATED DISORDERS: AN ENVIRONMENTAL GERONTOLOGY PERSPECTIVE

Behavioral and psychological symptoms of dementia create challenges for those living with neurodegenerative cognitive impairment and their care partners. Pharmacological approaches for treatment of challenging behaviors seen in dementia have limited success and serious side effects. Because of this, nonpharmacological approaches are being investigated with increasing frequency. Of particular interest are nonpharmacological approaches involving environmental stimulation to change behaviors. Success of such approaches relies on sensory processing systems, personal preferences, and environmental congruence. There is limited evidence describing behaviors of persons with cognitive impairment in relation to these components. Currently, there is no guiding model for implementation of environmental and sensory-based strategies with this population. The overall goal of this project is to elaborate on an emerging model describing the relationship among environment, behavior, sensation, and cognitive impairment for community-dwelling adults with mild cognitive impairment or dementia. Three studies allow for deeper understanding of this relationship. Study one compared behaviors seen in autism spectrum disorder (ASD) with exhibited behaviors of individuals with mild cognitive impairment or dementia. Of neurological conditions similar to dementia, ASD has been chosen as an exemplar for comparison of behavioral expression because evidence supports sensory-based theory and interventions to improve behaviors for those with ASD. Results indicate that ASD behaviors are reported in those assessed, with highest rates of behaviors in those with young age of onset and advanced cognitive impairment severity. Study two described presentation of behavior, sensory processing, and environment for community-dwelling adults with cognitive impairment in the context of the caregiver situation. Findings reflect dyadic experiences for the person with cognitive impairment and the primary care partner. Emergent themes included consideration of the passage of time, environmental contexts, behavioral adjustments while aging, and overall influences of living with cognitive impairment. Sensory processing assessment using the Adult Sensory Profile identified that all participants had some atypical sensory processing patterns, highlighting a need for attention to environmental congruence to promote adaptive behaviors. Using data collected in study one and study two, a model was created describing interactions among the person with cognitive impairment, sensation, and the environment as these interactions evolve over time. Areas for future research are conceptualized for implementation of the model. Future research is needed for assessment of the model to test for validity and reliability. Creation of an instrument is needed to place individuals within the model given their behavior and cognitive impairment progression. And, future research is needed to create and test interventions in order to aid in environmental congruence. Long-term goals are to improve care for adults with cognitive impairment and dementia via environmental interventions

Blood Transfusion Errors within a Health System: A Review of Root Cause Analyses

IntroductionBlood transfusions are lifesaving treatments which require critical attention to processes and details. If processes are not followed, grievous errors can lead to sentinel events. A review of investigations completed due to reported events will show the error trends associated with systems used throughout the blood transfusion process. MethodsThis study employed root cause analyses (RCAs) within the Veterans Health Administration (VHA) to review the events leading to blood transfusion errors. Data was pulled from the RCA databases within the VA National Center for Patient Safety. The time frame was October 2014 to August 2019. A total of 53 RCAs and aggregated reviews were included in the study. These were reviewed for common themes and gaps present within processes. ResultsThe most common events fell within the categories of incorrect or delayed blood orders, incorrect or lack of patient identification, and wrong blood given. The RCA for each event was reviewed and studied. The RCAs had a crossover of multiple causes; lack of a formal process, communication barriers, and technology barriers were the most frequent. ConclusionThese RCAs express great variation between VHA facilities, such as process created, number of staff reports, and number of RCAs completed. Lack of standard practices nationwide, training barriers, and technology barriers may explain the variation of transfusion errors throughout the VHA. This study brings to light questions about standardization of transfusion protocols. Future study regarding such standardization is necessary to determine its plausibility

Will Social Distancing Lead to Future Research Distancing : A Reflection on COVID-19 Impacts on Alzheimer\u27s Disease Research

Coronavirus disease 19 (COVID-19) has dramatically altered everyday life, including the field of Alzheimer\u27s disease (AD) research. This perspective article explores some of the ways in which COVID-19 has already impacted the field, anticipates some of the long-lasting effects, and explores strategies for addressing current and future needs. Areas of impact include study integrity, regulatory and industry issues, and participant engagement. Proposed strategies for addressing these challenges include analytic methods to deal with large degrees of missing data and development of patient-centered, user-friendly, remote data collection tools and assessments. We also highlight the importance of maintaining participant well-being as a first and constant priority

Sensory Processing Abnormalities in Community-Dwelling Older Adults with Cognitive Impairment: A Mixed Methods Study

Mild cognitive impairment (MCI) or dementia often leads to behavioral and psychiatric symptoms of dementia (BPSD). Sensory processing abnormalities may be associated with BPSD. The purpose of this study was to explore relationships among sensory processing, behavior, and environmental features within the homes of people with MCI or dementia. This project used mixed methods to assess participants’ sensory processing, care partner perspectives on behaviors, and in situ observations of the home environment. Nine participants with cognitive impairment (MCI n = 8, early dementia = 1) and their care partners were included. Seven participants with cognitive impairment were reported to have abnormal sensory processing. Findings suggest that unique environmental adaptations, tailored to personal and sensory preferences for each participant, were associated with a decreased level of behavioral disruption during the observation periods. Implementing sensory-based approaches to maximize environment adaptation may be beneficial in reducing disruptive behaviors for adults with cognitive impairment

190 Translating Alzheimer’s Disease Research to Improve Dementia Screening Through Health Message Design in the Community: A Qualitative Study

OBJECTIVES/GOALS: This study engaged Black adults who reside in a rural area of Kentucky to explore their beliefs, norms, knowledge, attitudes, and health-related behaviors about Alzheimer’s disease (AD) (RQ1) and what message elements are most relevant for designing a health message aimed at encouraging them to get screened for AD (RQ2). METHODS/STUDY POPULATION: This qualitative study was guided bythe Integrative Model of Behavior. Participants were recruited from a faith-based institution in rural Kentucky. Black adults aged 50+ years were invited to participate in the study, which consisted of two focus groups. Group 1 gained information about behavioral determinants (RQ1) and examined which message design elements were important to Black adults by asking for feedback on a handout from the Alzheimer’s Association that encouraged AD screening (RQ2). The handout was redesigned based on feedback from Group 1. Group 2 was involved in a discussion of the redesigned handout, asking for further feedback. Focus groups were audio recorded and transcribed verbatim. Data analysis included thematic analysis of transcripts of the focus groups and quantitative analysis. RESULTS/ANTICIPATED RESULTS: Participants (N=18) were all female and Black with a mean age of sixty-two years. For RQ1, Results revealed that 1) limited knowledge of AD led to feelings of not being able to do anything about the disease, whereas awareness and education led to hope; 2) past healthcare experiences informed subsequent beliefs and behaviors, and 3) culture impacted beliefs, with a cultural norm of “what happens in our house, stays in our house” being prominent. For RQ2, results revealed the importance of regionally specific messaging for AD. Generic statements that applied broadly did not appeal to participants. Message delivery, layout, and format for low literacy individuals are key for maximizing audience impact. Pictures give hints about the message and aid in understanding. DISCUSSION/SIGNIFICANCE: Barriers such as past experiences, lack of knowledge, and cultural norms negatively impact the likelihood that Black adults will get screened for AD, resulting in delayed healthcare or healthcare avoidance. Regionally specific health messaging for AD has the potential to encourage modifications in health-related behaviors

Blood Transfusion Errors Within a Health System: A Review of Root Cause Analyses

Introduction Blood transfusions are lifesaving treatments which require critical attention to processes and details. If processes are not followed, grievous errors can lead to sentinel events. A review of investigations completed due to reported events will show the error trends associated with systems used throughout the blood transfusion process. Methods This study employed root cause analyses (RCAs) within the Veterans Health Administration (VHA) to review the events leading to blood transfusion errors. Data was pulled from the RCA databases within the VA National Center for Patient Safety. The time frame was October 2014 to August 2019. A total of 53 RCAs and aggregated reviews were included in the study. These were reviewed for common themes and gaps present within processes. Results The most common events fell within the categories of incorrect or delayed blood orders, incorrect or lack of patient identification, and wrong blood given. The RCA for each event was reviewed and studied. The RCAs had a crossover of multiple causes; lack of a formal process, communication barriers, and technology barriers were the most frequent. Conclusion These RCAs express great variation between VHA facilities, such as process created, number of staff reports, and number of RCAs completed. Lack of standard practices nationwide, training barriers, and technology barriers may explain the variation of transfusion errors throughout the VHA. This study brings to light questions about standardization of transfusion protocols. Future study regarding such standardization is necessary to determine its plausibility

Playfulness for Brain Health in in Mid- & Late-Life: Scoping Review to Support Preventive Non-Pharmacological Interventions Across the Lifespan

98th ACRM Annual Conferenc

Sensory Processing and Behaviors Characteristic of Autism Spectrum Disorder in Older Adults with Cognitive Impairment

Aging with cognitive impairment creates a myriad of behavioral changes for individuals. Information provided within this dataset represents a small study exploring behaviors characteristic of autism spectrum disorder and sensory processing abilities in community-dwelling older adults with cognitive impairment. With better understanding of behavioral phenotypes present in cognitive impairment, novel intervention options may be warranted.https://uknowledge.uky.edu/sbcoa_data/1000/thumbnail.jp

Playfulness for Brain Health in Community Settings: Preliminary Analysis from a Systematic Scoping Review to Support Non-Pharmacological Interventions

Alzheimer’s Association International Conference (AAIC) Satellite Symposiu

Associations of Future Cognitive Decline with Sexual Satisfaction among Married Older Adults

Objectives: This study sought to explore changes in longitudinal cognitive status in relation to baseline measures of intimacy and sexuality in cognitively intact, married older adults. Methods: Baseline intimacy and sexuality survey data from 155, cognitively intact, married, older adults were collected using a novel survey instrument that explored the domains of: 1) romance with one's partner, 2) sexual satisfaction, 3) beliefs about sexuality, and 4) social support and emotional intimacy. These data were analyzed in relation to change in cognitive status over a 10-year follow-up period using binary logistic regression modeling. Exploratory factor analysis was used to assess the shared variance of survey items attributable to intimacy and sexuality without specification of an a priori hypothesis regarding the association of intimacy and sexuality with future change in cognitive status. Results: Over the 10-year study period, 33.5% (n = 52) of individuals developed cognitive impairment. Participants with greater sexual satisfaction scores at baseline were statistically less likely to convert from cognitively intact to mild cognitive impairment or dementia in the future (p = .01). The domains of romance with one's partner, beliefs about sexuality, and social support/emotional intimacy were not predictive of future longitudinal changes in cognitive status. Conclusions: Sexual satisfaction is associated with longitudinal cognitive outcomes in cognitively intact, married, older adults. Clinical implications: Clinicians should routinely assess for sexual satisfaction among older adults and refer to appropriate providers, such as couples or sex therapists, when appropriate