COGNITIVE INTRAINDIVIDUAL VARIABILITY TO MEASURE INTERVENTION EFFECTIVENESS: BALTIMORE EXPERIENCE CORPS TRIAL

Abstract Studies investigating the effectiveness of intervention programs on cognitive ability in older adults are equivocal; however, these studies generally focus on traditional measures of cognition, and therefore may miss some improvements by not utilizing alternate measures. We evaluate the potential for intraindividual variability in cognitive speed (IIV), a demonstrated sensitive indicator of cognitive functioning, to be used as an index of cognitive plasticity from an intervention. The current study evaluated whether older adults in a school volunteering program showed a reduction in IIV, compared to a low-activity control group over two years of exposure. Non-demented aging older adults (n = 336) participated in the Baltimore Experience Corps Trial, an evaluation of a volunteering program conducted at elementary schools designed to increase older adults’ physical, cognitive, and social engagement. Participants completed a cognitive battery that included a computerized Stroop task at baseline and after 12 and 24 months. Participants who complied at the 80th percentile or above showed a significant reduction in IIV at 24 months, with an additional trend of improved IIV with increased compliance to the treatment protocol, both at 12 months, and at 24 months. Men specifically also showed significant dose-dependent improvements after 12 months. The Experience Corps program resulted in an improvement in cognitive performance as measured by IIV. Analyzing previously collected data with non-traditional measures of cognition, such as IIV, may be a potentially fruitful and cost-effective method for understanding how interventions impact cognition in aging populations.

conceptual framing, this study explored age-related participant-researcher dynamics in interviews from two qualitative studies of older women's sexual experiences in later life. Participants included 25 women whose ages ranged from 55 to 93 and both studies were completed by the same researcher, a relatively younger woman (age 23 and 28 at times of data collection). A thematic analysis revealed three primary themes: 1) taking care -participants took care of the researcher by offering advice, asking about the researcher's life, and expressing hopes for a positive future, 2) expertise -varied expertise was demonstrated by the researcher (e.g. substantive and scholarly) and participants (e.g. life experience), and 3) researcher growth -the researcher's interviewing tactics shifted between the two studies (e.g. use of validation rather than consolation in response to aging-related concerns), indicating a shift in perceptions of aging and later life. Findings indicate that older women participants and younger women researchers are bound together through the life course, by shared gendered experiences, the fact that one will eventually become the other, and the mutual sharing of expertise and caring. Gerontology researchers must actively reflect on the impact of their own identities and aging perceptions on the interviewing process in order to enhance rigor in qualitative research. Guidelines for self-report assessment with older adults emphasize the use of shorter Likert-type or agree/disagree response formats to reduce cognitive load (e.g., Yesavage et al., 1983). However, these suggestions are not founded on empirical studies directly comparing younger and older adults' responses on different scales. Thus, the current study tested differential responding on varying Likert-type response scale lengths between younger, middle-aged, and older adults. Participants completed three versions of the International Personality Item Pool (IPIP) Neuroticism scale with 3, 5, and 7 Likert-type response scale lengths in counterbalanced orders with other questionnaires between versions. Six multi-group confirmatory factor analyses (CFAs) assessed measurement invariance across scale lengths and age groups. Invariance of convergent validity networks was also assessed with multi-group CFAs of the associations between the IPIP and measures of depression, anxiety, anger, worry, and affect. The final sample consisted of 835 adults (327 18-44; 279 45-64; and 229 65 or older) via Amazon Mechanical Turk. Measurement invariance was supported in analyses by age within each scale length and by scale length within each age group, indicating that response patterns across all scale lengths and age groups did not significantly differ. Analyses of convergent validity also supported invariance, suggesting that responses across all scale lengths and age groups reflect the same underlying construct. This study indicates that, among community-dwelling adults, shortened response scale lengths do not yield significantly different or more valid responses for older adults compared to younger adults. Polypharmacy is associated with increased health care costs and adverse health outcomes. Traditional research on polypharmacy uses dichotomous measures which overlook its multidimensional nature. We propose a new approach to grouping older adults based on the number and type of medications taken as well as other indicators of polypharmacy. Data was extracted from 1328 respondents of the 2007 Prescription Drug Survey (a sub-study of the Health Retirement Study) who were between 50 and 70 years old and taking ≥1 medication each month. Latent class analysis was carried out with the optimal number of classes assessed based on relative model fit (AIC, adjusted BIC) and interpretability. Latent classes were formed based on the number of medications, drug types, duration of medication intake, side effects, and presence of chronic health conditions. A four-class model was selected based on model fit and interpretability of the solutions. Although there was some overlap when we compared our model with standard cut-offs for polypharmacy (i.e., 'high polypharmacy' classes were more likely to take 5+ and 9+ medications), chi-square tests showed significant differences between our latent classes and cut-offs based on 5+ [X2 = 894; p<0.001] and 9+ medications [X2 = 398; p<0.001]. Among individuals taking <5 medications, our model differentiated two distinct types of 'low polypharmacy' based on the types of drugs reported. Our proposal to incorporate a multidimensional assessment of polypharmacy considers the wider context of medication use and chronic health in older age, moving beyond crude medication counts.

. Leibniz Institute for Prevention Research and Epidemiology -BIPS, Bremen, Germany
Studies investigating the effectiveness of intervention programs on cognitive ability in older adults are equivocal; however, these studies generally focus on traditional measures of cognition, and therefore may miss some improvements by not utilizing alternate measures. We evaluate the potential for intraindividual variability in cognitive speed (IIV), a demonstrated sensitive indicator of cognitive functioning, to be used as an index of cognitive plasticity from an intervention. The current study evaluated whether older adults in a school volunteering program showed a reduction in IIV, compared to a low-activity control group over two years of exposure. Non-demented aging older adults (n = 336) participated in the Baltimore Experience Corps Trial, an evaluation of a volunteering program conducted at elementary schools designed to increase older adults' physical, cognitive, and social engagement. Participants completed a cognitive battery that included a computerized Stroop task at baseline and after 12 and 24 months. Participants who complied at the 80th percentile or above showed a significant reduction in IIV at 24 months, with an additional trend of improved IIV with increased compliance to the treatment protocol, both at 12 months, and at 24 months. Men specifically also showed significant dosedependent improvements after 12 months. The Experience Corps program resulted in an improvement in cognitive performance as measured by IIV. Analyzing previously collected data with non-traditional measures of cognition, such as IIV, may be a potentially fruitful and cost-effective method for understanding how interventions impact cognition in aging populations.

THE EFFECT OF COGNITIVE TESTING ON STATE ANXIETY AND CORTISOL REACTIVITY IN YOUNGER AND OLDER ADULTS
MacKenzie L. Hughes, 1 Ann Pearman, 1 and Shevaun D. Neupert 2 , 1. Georgia Institute of Technology, Atlanta,Georgia,United States,2. North Carolina State University,Raleigh,North Carolina,United States Although it is well established that stress is negatively associated with cognitive functioning, less is known about age differences in the effects of stressors and anxiety on state anxiety and physiological reactivity (i.e., changes in cortisol). The current study examined state anxiety and cortisol reactivity during a series of cognitive tasks in a sample of younger (n=26) and older (n=29) adults. Participants completed the State-Trait Anxiety Inventory prior to cognitive testing and provided six salivary cortisol samples throughout one testing session: two cortisol samples prior to cognitive testing, three samples during testing, and one sample after testing. Six cognitive tasks were administered that measured attention span, declarative memory, and processing speed. Results indicated a significant interaction effect of age by time with younger adults' cortisol linearly decreasing during the testing session and older adults' cortisol showing a quadratic trend. A second interaction was found between age and state anxiety whereby older adults who reported more anxiety had higher cortisol levels during the cognitive testing session than both the older adults who reported low levels of anxiety and the younger adults. Only age (not cortisol or anxiety) was significantly related to cognitive performance. Results from this study suggest that standard cognitive testing could be anxiety producing for older adults, particularly for those who are already anxious. Future investigations should examine age-related differences in the processes linking anxiety and cortisol to specific types of performance, such as memory and attention.

EMERGING MODELS OF CARE: THE IMPACT OF PHARMACIST-LED MEDICATION MANAGEMENT IN A TRANSITIONAL CARE PROGRAM
Ebony Andrews, 1 Travonia Brown-Hughes, 1 Ronald Lyon, 1 Shanea D. Parker, 1 and Brad Lazernick 2 , 1. Hampton University,Hampton,Virginia,United States,2. Senior Services of Southeastern Virginia,Norfolk,Virginia,United States Transitional care programs have emerged as successful models of care in which to reduce cost and improve health outcomes. However, few transitional care models have directly incorporated the expertise of the pharmacist as an integral member of the care coordination team. Therein lies an inherent limitation of many community-based transitional care programs, the underutilization of pharmacist during all stages of the care transition process. In 2013, the Hampton Roads Care Transitions Project (HRCTP), a partnership between Senior Services of Southeastern Virginia Area Agency on Aging in Norfolk, VA and Hampton University School of Pharmacy, was established. The goal of the HRCTP is to provide medication management services to reduce preventable hospital readmissions for adults 60 years of age and older with targeted diagnoses. Pharmacists work in collaboration with social workers who act as HRCTP care transition coaches. Between May 2017-October 2018, 678 patients were enrolled in the HRCTP. The hospital readmission rate among patients with targeted diagnoses was reduced by 55.3% with an absolute percentage point reduction of 9.9% and estimated savings amount per avoided readmission of $14,400. Patients who participated in the HRCTP showed a 14% increase in the Patient Activation Assessment indicating an improvement in self-managing efficacy. 93% of patients/caregivers indicated they felt more confident in their ability to manage their health, and 91% expressed satisfaction with the program. The program has proven effective in assisting seniors to remain in their home, reducing hospitalizations, promoting health, increasing patient satisfaction, and reducing healthcare cost.

A SIMPLE INTERVENTION TO REDUCE ANTICHOLINERGIC DRUG USE WHILE ATTENDING A GERIATRIC DAY HOSPITAL
Costa Apostolides 1 , 1. Dalhousie University, Halifax, Nova Scotia, Canada Attendance at a Geriatric Day Hospital has previously been shown to reduce both the overall number of medications and the number of anticholinergic medications of patients. In the present study, patients enrolled in a Geriatric Day Hospital program from January to February 2019 were divided into a control and intervention group. Anticholinergic medications in the intervention group were flagged by highlighting them in the patient chart and alerting the attending clinician, whereas no alerts were provided in the control group. Anticholinergic load was calculated using the Anticholinergic Cognitive Burden (ACB) and Drug Burden Index (DBI) scores. In comparing admit versus discharge medications in the intervention group, both the mean number of overall medications