Evaluating Cognitive Impairment in a Large Health Care System: The Cognition in Primary Care Program

Background

The prevalence of Alzheimer's disease and related disorders (ADRD) is rising. Primary care providers (PCPs) will increasingly be required to play a role in its detection but lack the training to do so.

Objective

To develop a model for cognitive evaluation which is feasible in primary care and evaluate its implementation in a large health system.

Methods

The Cognition in Primary Care Program consists of web-based training together with integrated tools built into the electronic record. We implemented the program among PCPs at 14 clinics in a large health system. We (1) surveyed PCPs to assess the impact of training on their confidence to evaluate cognition, (2) measured the number of cognitive assessments they performed, and (3) tracked the number of patients diagnosed with mild cognitive impairment (MCI).

Results

Thirty-nine PCPs completed the training which covered how to evaluate cognition. Survey response rate from those PCPs was 74%. Six months after the end of the training, they reported confidence in assessing cognition (mean 4.6 on 5-point scale). Cognitive assessments documented in the health record increased from 0.8 per month before the training to 2.5 in the six months after the training. Patients who were newly diagnosed with MCI increased from 4.2 per month before the training to 6.0 per month in the six months after the training.

Conclusions

This model for cognitive evaluation in a large health system was shown to increase cognitive testing and increase diagnoses of MCI. Such improvements are essential for the timely detection of ADRD.

Abstract P187: Qualitative Description of Physical Activity Perceptions and Experiences in Older Adults With HIV

Background: The benefits of physical activity, and specifically exercise, among older adults are well known. Yet, globally there is concern regarding limited engagement in physical activity and rising cases of obesity and frailty among older people with HIV (PWH). We explored the experiences and perceptions of PWH enrolled in the High-intensity Exercise study to Attenuate Limitations and Train Habits (HEALTH) study.

Methods: Thirty-two participants were enrolled between February 2021 and August 2022. We conducted in-depth interviews among sedentary, older PWH in the ongoing HEALTH (NCT04550676) study. A semi-structured interview guide was informed by the two minds theory, which frames behavior change as an intention-behavior gap between two neurocognitive systems. The intuitive system, described as immediate or first reactions, optimizes behavior based on its expected consequences at the moment, whereas the narrative system produces beliefs about possible behavior in the future sequentially and thoughtfully. Interviews explored general exercise perceptions, self-efficacy for exercise, mobile health intervention tailoring, outcome expectations and goals for physical activity. Interviews were transcribed verbatim, and a three-member study team employed deductive and inductive thematic analysis using Dedoose. The sample size provided sufficient data to reach saturation.

Results: Physical activity was perceived as the ability to maintain daily living activities and address health goals such as becoming and maintaining physical fitness. Previous experiences with physical activity varied among participants and were influenced by chronic illnesses, motivation and interest in physical activity, and availability of social support. Congruent with the two-minds theory, participants reported intuitive-level experiences as barriers to physical activity. These include antiretroviral side effects, lack of self-confidence, and aging. COVID-19 was also noted as a significant barrier. Consistent with the narrative system, participants identified changes in health status, feeling better and having improved sleep, body changes (e.g., weight loss), and changes in relationships as reasons for and benefits of physical activity. Additionally, most participants reported lifestyle changes such as quitting substance use, diet changes, and changes to their social network, all of which helped sustain their increased physical activity. PWH felt that conversations with their healthcare providers supporting their exercise goals was critical to helping them engage in physical activity, but was rarely received.

Conclusion: Understanding how older PWH experience and perceive physical activity is critical to developing tailored strategies and structuring service delivery within the healthcare setting to improve health by supporting a physically active life.

MANAGING YOUR OWN WELLNESS: A PILOT INTERVENTION TO IMPROVE DEMENTIA CARE PARTNER SELF-CARE

Engagement in regular self-care activities could mitigate and reduce the risk of negative health outcomes in dementia care partners (CP), yet many report that they do not prioritize wellness-related activities for themselves. We conducted a pilot of a virtual technology-supported intervention with 19 dementia CP to evaluate usability, feasibility, acceptability, and preliminary effectiveness of cultivating daily self-care habits and creating a wellness routine based on personalized self-care goals. Case studies and inductive thematic analyses suggested that the intervention could help CP meet their self-care activity goals, improve their sense of well-being and capacity to provide care. After establishing the initial feasibility and usability of the intervention and the online goal-setting and tracking platform, we collaborated with scientists specializing in Human-Centered Design and Engineering to develop a prototype of a mobile application that will optimize portability, utility, and support testing of this intervention.

Striking a chord: Utilizing music for people living with dementia

This article discusses how music therapy can be incorporated into nursing practice for people living with dementia.