- Recent reports from the World Health Organization, the Institute of Medicine, and the Centers for Disease Control and Prevention emphasize that cognitive health and physical functioning are interdependent and essential to well-being in older adults. Two NW Roybal pilot research projects are currently underway to investigate interrelationships between cognitive and physical function, and to identify strategies to improve cognitive health, reduce falls and maintain mobility in community dwelling older adults with mild to moderate cognitive impairment.
A Pilot Study to Reduce Fall Risk in Persons with Mild Cognitive Impairment
Approximately one in three older adults fall annually and falls are the primary cause of traumatic injury in older adults. Prevention of falls is a significant public health priority, as one of the Healthy People 2020 goals is to reduce the rate of emergency department visits by older adults due to falls by 10%. While exercise and balance programs have been shown to be effective in reducing fall risk, maintaining behavior change is known to be difficult. Thus additional interventions need to be validated to add to our current armamentarium to reduce falls in older adults. Recent work has pointed to an increased risk of falls in community-dwelling older adults who have alterations in specific cognitive tasks, particularly those related to executive function. Cognitive training (CT) involves exercises that target specific cognitive tasks like executive function. It has been speculated that routinely performing such tasks may increase overall functional ability. Thus the purpose of the proposed study is to demonstrate the feasibility of a CT intervention to reduce risk of fall and fall-related outcomes in a group of older adults with cognitive impairment at risk for fall.
Hilaire Thompson, PhD, RN, ACNP-BC, CNRN, FAAN is an Assistant Professor in Biobehavioral Nursing and Health Systems at the University of Washington. Dr. Thompson's program of research has focused on both preventing and improving outcomes from traumatic brain injury, with a particular emphasis on older adults. Together with collaborators, she is examining ways in which technology can aid injury prevention for older adults.
Functional Markers of Mobility Disability in Older Adults with Cognitive Impairment
Mobility disability and fall-related injuries increase with advancing stages of Alzheimer's disease. A reduction in functional mobility often precedes the onset of dementia, and increased assistance is needed for daily activities during advancing stages of disease. The overall objective of this study is to identify functional markers of mobility disability in older adults with mild cognitive impairment and Alzheimer's disease. For this study, laboratory-based and portable quantitative motion analysis systems will be utilized to develop sensitive assessment tools of functional mobility that can be used in the homes of older adults with cognitive impairment.
This research aims to bridge the gap between laboratory and in-home assessments of functional mobility in older adults with cognitive impairment and lead to early detection of mobility problems. This research has implications for the development of new strategies to assist older adults with Alzheimer's disease to maintain relative independence within their own homes.
Ellen McGough, PT, PhD is an Assistant Professor in the Department of Rehabilitation Medicine. Her research focuses on studying functional markers of mobility disability and the effects of exercise interventions in older adults with neurodegenerative disease. Of particular interest are early markers that are responsive to exercise interventions for prevention and rehabilitation of disability in older adults with Alzheimer's and Parkinson's disease. She uses laboratory-based and portable quantitative motion analysis technology and performance-based testing to examine walking and mobility in older adults with varying levels of cognitive and physical impairment. She is also studying the effects of structured exercise programs for individuals with Alzheimer's and Parkinson's disease. The overarching goal of her research program is to develop strategies to assist older adults with cognitive and motor impairments to maintain relative independence within their own homes.
PAST PILOT PROJECTS:
Behavioral Disturbances, Dementia, and Adult Family Homes
Susan McCurry, Principal Investigator, focused on the development of a train-the-trainer intervention to help staff in adult family homes better manage mood and behavioral disturbances in their residents with dementia. This training program (S.T.A.F.F. – Staff Training in Adult Family home Facilities) builds upon two evidence-based interventions developed by the PI and colleagues that have been shown to be efficacious in reducing mood and behavior problems in persons with dementia. Twenty adult family homes were enrolled in the year-long pilot project.
Susan McCurry, PhD is clinical psychologist and research professor in the Department of Psychosocial & Community Health, University of Washington School of Nursing, specializing in gerontology and geriatrics. Her research focuses on evaluating and treating behavior problems in dementia, including the sleep disturbances experienced by many Alzheimer's disease patients and their caregivers. In addition, she is interested in cross-cultural differences in dementia patterns and prevalence rates, and the environmental, behavioral, and psychosocial factors that correlate with successful aging.
Cognitive Function and Breast Cancer Care
Jessica Chubak, Principal Investigator, conducted her work at Group Health Cooperative, focusing on the extent to which cognitive function is assessed and documented in the medical record of older women with breast cancer at the time of their cancer diagnosis. Furthermore, the project examined whether treatment and surveillance patterns differed based on cognitive function. This study sought to address knowledge gaps in the interface between breast cancer care and cognitive status, an area in which little research has been conducted.
Jessica Chubak, PhD. is an epidemiologist with experience in pharmacoepidemiology, cancer prevention, epidemiologic methods, and healthcare issues of relevance to older women. She is an Assistant Scientific Investigator at Group Health Center for Health Studies and holds an affiliate appointment in the Department of Epidemiology at the University of Washington. She has conducted research in the areas of medication use and breast cancer recurrence and survival, hormone therapy and endometrial cancer, and biomarkers in cancer prevention.