- Email: [email protected]
AN INNOVATIVE NEW ENVIRONMENT FOR OLDER ADULTS WITH DEMENTIA: AN URBAN LTCF IN JAPAN
P576
Poster Presentations: P2
Table 3 The role of health behaviors in explaining changes in cognitive function as measured by MMSE differences Variables
Unadjusted b (SE)
Adjusted b (SE)
Physical Activity (min/day) Cognitive Activity (min/day) Social Activity (min/day) Smoking (yes/no) Alcohol Drinking (AUDIT) Healthy Diet (MDA)
0.13 (0.43) 1.24 (0.42)** -0.02 (0.42) 0.56 (0.79) 0.32 (0.56) 0.91 (0.44)*
0.06 (0.42) 1.04 (0.40)** -0.05 (0.41) 1.25 (0.79) 0.54 (0.53) 0.72 (0.41)
Adjusted for age, sex, education, depressive symptoms and anxiety Reference group: Smoking (NO) * p < 0.05, ** p < 0.01. MMSE: Mini-Mental State Examination AUDIT: Alcohol Use Disorder Identification Test MDA: Mini Dietary Assessment Table 4 Health behavior changes according to intervention group compared with standard care Group A after 18 months Alcohol Healthy drinking diet Variables (AUDIT) (MDA)
Physical activity (min/day)
Cognitive activity (min/day)
Social activity (min/day)
Group B Group C Group D Group E
0.83 1.33 4.78 -5.74
0.21 0.20 0.26 0.92*
0.91 2.35 2.41 1.61
0.35 0.25 0.17 0.63
2.91** 1.50* 1.40 2.29**
Project Description: Although there is no cure for Alzheimer’s disease, there are several therapy options. One of the keys to delaying dementia among older adults is the physical environment. However, urban facilities, surrounded by high-rise buildings, can limit access to the outdoors. At a two-story LTCF (50 residents/unit, av. age 88 6 4.1, FAST level:5-7) in central Japan, a garden for dementia afflicted residents was created on the rooftop with the following features: a variety of plants and flowers, naturally mapped physical design, drainage, and fall-prevention. Upon consultation with an area botanical expert, the researcher chose flora specific to the area which residents would be familiar with. Within the same LTCF, landscapes familiar to the residents were painted on murals, bringing nostalgic outdoor views within reach of residents unable to go outside. To create this painting, local historical data (photos and news), was used so that the wall painting was not only a substitute for a real outside view but also represented residents’ memories of their youth. This is an example of bringing the outside world indoors for residents unable to go outside or for whom the view is obstructed by large buildings. Design adaptations work to improve functionality by reducing demands on the individuals’ already-challenged perception while simultaneously continuing to stimulate the five senses as often as possible. After completion of the roof-top garden and mural painting, 50% of the residents visit the garden 1-2 times/week and all residents unless bed-ridden otherwise visit the mural at least once a day. Analyzed conversation and words of five residents (10%) during their visits, and the following three key words were extracted most: "remember" "dear" "beautiful." No negative words were extracted.
Value means standardized b coefficient. Positive value indicates good result. Reference group: Standard care group A *p < 0.05, y p < 0.1. Group A: control Group B: telephone care management once every two months Group C: telephone care management monthly Group D: health worker-initiated visit care management once every two months Group E: Group D + rewards MMSE: Mini-Mental State Examination AUDIT: Alcohol Use Disorder Identification Test MDA: Mini Dietary Assessment tween 2008 and 2010. We developed an intervention based on the principles of contingency management, which could be delivered by ordinary primary health workers. Group A (n ¼ 81) received standard care services. Group B (n ¼ 80) received once every two months telephonic care management based on our method. Group C (n ¼ 111) received monthly telephonic care management and educational materials similar to those in Group B. Group D (n ¼ 93) received once every two months health worker-initiated visits and counseling. Group E (n ¼ 94) received once every two months health worker-initiated visits, counseling, and rewards that consisted of symbolic gold medals. The primary outcome was the change in Mini-Mental State Examination (MMSE) scores from baseline to final follow-up visit at 18 months. Group E showed superior cognitive function to Group A (adjusted coefficient b ¼ 0.99, p ¼ 0.044), with engagement in cognitive activity being the most important determining factor among several health behaviors (adjusted coefficient b ¼ 1.04, p < 0.01). Encouragement of cognitive activity, with positive health behaviors, may be most beneficial in preserving the cognitive abilities of community-dwelling older adults. P2-272
AN INNOVATIVE NEW ENVIRONMENT FOR OLDER ADULTS WITH DEMENTIA: AN URBAN LTCF IN JAPAN
Kazuyo Kanzaki-Sooudi1, 1Sapporo City University, Sapporo, Japan. Contact e-mail: [email protected]
P2-273
EXPANDING A PERSON-CENTERED MEDICAL HOME FOR PEOPLE WITH DEMENTIA
Larry Lawhorne1, Katherine L. Cauley1, 1Wright State University Boonshoft School of Medicine, Dayton, Ohio, United States. Contact e-mail: [email protected] Project Description: In previous studies, we reported on a pilot project in which 40 households in a suburban area of the U.S. were enrolled in a person-centered medical home for people with dementia (PCMH PwD). Each household had a person with dementia and at least one informal caregiver. Caregivers reported high levels of satisfaction and follow-up surveys suggested that timely telephone access to a member of the PCMH PwD team prevented an average of 3 emergency department visits per household per year. Estimated cost of providing 24/7 telephone access to a member of the PCMH PwD team was $ 40.00 / household per month. The PCMH PwD was developed and implemented in an ambulatory clinic population comprised largely of non-Hispanic white, middle class patients. The purpose of the current study is to determine if the PCMH PwD model can be adapted to meet the needs of residents in predominantly African American,
Poster Presentations: P2
Table 3 The role of health behaviors in explaining changes in cognitive function as measured by MMSE differences Variables
Unadjusted b (SE)
Adjusted b (SE)
Physical Activity (min/day) Cognitive Activity (min/day) Social Activity (min/day) Smoking (yes/no) Alcohol Drinking (AUDIT) Healthy Diet (MDA)
0.13 (0.43) 1.24 (0.42)** -0.02 (0.42) 0.56 (0.79) 0.32 (0.56) 0.91 (0.44)*
0.06 (0.42) 1.04 (0.40)** -0.05 (0.41) 1.25 (0.79) 0.54 (0.53) 0.72 (0.41)
Adjusted for age, sex, education, depressive symptoms and anxiety Reference group: Smoking (NO) * p < 0.05, ** p < 0.01. MMSE: Mini-Mental State Examination AUDIT: Alcohol Use Disorder Identification Test MDA: Mini Dietary Assessment Table 4 Health behavior changes according to intervention group compared with standard care Group A after 18 months Alcohol Healthy drinking diet Variables (AUDIT) (MDA)
Physical activity (min/day)
Cognitive activity (min/day)
Social activity (min/day)
Group B Group C Group D Group E
0.83 1.33 4.78 -5.74
0.21 0.20 0.26 0.92*
0.91 2.35 2.41 1.61
0.35 0.25 0.17 0.63
2.91** 1.50* 1.40 2.29**
Project Description: Although there is no cure for Alzheimer’s disease, there are several therapy options. One of the keys to delaying dementia among older adults is the physical environment. However, urban facilities, surrounded by high-rise buildings, can limit access to the outdoors. At a two-story LTCF (50 residents/unit, av. age 88 6 4.1, FAST level:5-7) in central Japan, a garden for dementia afflicted residents was created on the rooftop with the following features: a variety of plants and flowers, naturally mapped physical design, drainage, and fall-prevention. Upon consultation with an area botanical expert, the researcher chose flora specific to the area which residents would be familiar with. Within the same LTCF, landscapes familiar to the residents were painted on murals, bringing nostalgic outdoor views within reach of residents unable to go outside. To create this painting, local historical data (photos and news), was used so that the wall painting was not only a substitute for a real outside view but also represented residents’ memories of their youth. This is an example of bringing the outside world indoors for residents unable to go outside or for whom the view is obstructed by large buildings. Design adaptations work to improve functionality by reducing demands on the individuals’ already-challenged perception while simultaneously continuing to stimulate the five senses as often as possible. After completion of the roof-top garden and mural painting, 50% of the residents visit the garden 1-2 times/week and all residents unless bed-ridden otherwise visit the mural at least once a day. Analyzed conversation and words of five residents (10%) during their visits, and the following three key words were extracted most: "remember" "dear" "beautiful." No negative words were extracted.
Value means standardized b coefficient. Positive value indicates good result. Reference group: Standard care group A *p < 0.05, y p < 0.1. Group A: control Group B: telephone care management once every two months Group C: telephone care management monthly Group D: health worker-initiated visit care management once every two months Group E: Group D + rewards MMSE: Mini-Mental State Examination AUDIT: Alcohol Use Disorder Identification Test MDA: Mini Dietary Assessment tween 2008 and 2010. We developed an intervention based on the principles of contingency management, which could be delivered by ordinary primary health workers. Group A (n ¼ 81) received standard care services. Group B (n ¼ 80) received once every two months telephonic care management based on our method. Group C (n ¼ 111) received monthly telephonic care management and educational materials similar to those in Group B. Group D (n ¼ 93) received once every two months health worker-initiated visits and counseling. Group E (n ¼ 94) received once every two months health worker-initiated visits, counseling, and rewards that consisted of symbolic gold medals. The primary outcome was the change in Mini-Mental State Examination (MMSE) scores from baseline to final follow-up visit at 18 months. Group E showed superior cognitive function to Group A (adjusted coefficient b ¼ 0.99, p ¼ 0.044), with engagement in cognitive activity being the most important determining factor among several health behaviors (adjusted coefficient b ¼ 1.04, p < 0.01). Encouragement of cognitive activity, with positive health behaviors, may be most beneficial in preserving the cognitive abilities of community-dwelling older adults. P2-272
AN INNOVATIVE NEW ENVIRONMENT FOR OLDER ADULTS WITH DEMENTIA: AN URBAN LTCF IN JAPAN
Kazuyo Kanzaki-Sooudi1, 1Sapporo City University, Sapporo, Japan. Contact e-mail: [email protected]
P2-273
EXPANDING A PERSON-CENTERED MEDICAL HOME FOR PEOPLE WITH DEMENTIA
Larry Lawhorne1, Katherine L. Cauley1, 1Wright State University Boonshoft School of Medicine, Dayton, Ohio, United States. Contact e-mail: [email protected] Project Description: In previous studies, we reported on a pilot project in which 40 households in a suburban area of the U.S. were enrolled in a person-centered medical home for people with dementia (PCMH PwD). Each household had a person with dementia and at least one informal caregiver. Caregivers reported high levels of satisfaction and follow-up surveys suggested that timely telephone access to a member of the PCMH PwD team prevented an average of 3 emergency department visits per household per year. Estimated cost of providing 24/7 telephone access to a member of the PCMH PwD team was $ 40.00 / household per month. The PCMH PwD was developed and implemented in an ambulatory clinic population comprised largely of non-Hispanic white, middle class patients. The purpose of the current study is to determine if the PCMH PwD model can be adapted to meet the needs of residents in predominantly African American,