Disability Prevention Program Improves Life-Space and Falls Efficacy: A Randomized Controlled Trial

Abstract Life-space and falls efficacy are essential to physical independence and consistently predict disabilities. However, it remains unknown whether the CAPABLE, a disability prevention program, improves life-space and falls efficacy in older adults. We evaluated the effects of a home-based disability prevention program on life-space (N=194) and falls efficacy (N=233) among low-income older adults with restricted daily activities. The CAPABLE intervention consists of up to 6 one-hour home visits with an Occupational Therapist (OT), up to 4 one-hour home visits with a Register Nurse (RN), and up to $1300 worth of home repairs, modifications, and assistive devices with a handyman, during four months. Life-space and falls efficacy were measured by the Telephone Assessment of Mobility for homebound older adults and the Tinetti Falls Efficacy Scale at baseline and five months, respectively. Multinomial logistic regression and generalized linear models were used for data analyses. Participants in both samples were, on average, 75 years, predominantly black (86%) and female (85%-86%). Compared to participants in the control group, participants receiving the intervention were more likely to have improved (Odds Ratio [OR]: 2.10, 95% CI: 1.06-4.20) or unchanged overall life-space (OR: 2.62, 95% CI: 1.10-6.27) vs. decreased overall life-space. Participants who received the intervention also had significantly higher falls efficacy in performing daily activities (exponentiated coefficient: 1.11, 95% CI: 1.04-1.19). Life-space and falls efficacy can be significantly improved by CAPABLE program. These findings provide more evidence for the reasons for the increased physical independence.

dyslipidemia increased the explained variation to 8% and 10 %, respectively.The risk of becoming a dual-decliner was 4-fold if hypertension was present.CONCLUSION: Older adults with concurrent decline in gait speed and cognition represent a group at the highest risk of progression to dementia.These dual-decliners have a distinct phenotype with a higher prevalence of hypertension, a potentially treatable condition.

RECRUITMENT OF A DIVERSE RESEARCH COHORT IN A LARGE METROPOLITAN AREA FOR DEMENTIA INTERVENTION STUDIES
Melissa Reuland, 1 Deirdre Johnston, 2 Inga Antonsdottir, 3  Morgan Bunting, 4 and Quincy Samus, 5 1.Johns Hopkins University School of Medicine,Baltimore,Maryland,United States,2. Johns Hopkins Hospital,Baltimore,Maryland,United States,3. Johns Hopkins School of Nursing,Baltimore,Maryland,United States,4. Johns Hopkins University,Halethorpe,Maryland,United States,5. Johns Hopkins University,Baltimore,Maryland,United States In the near future, the costs, both human and financial, of dementia care will grow exponentially.Over five and a half million older Americans are estimated to be living with Alzheimer's disease and related dementia (ADRD).By 2050, this is expected to increase to over 13 million, with persons of color being at the highest risk for developing dementia.Considerable federal, state and private funds have been committed to research to prevent, treat, and care for persons at risk for ADRD.However, enrollment of research participants, particularly those coming from diverse backgrounds into studies, is a perennial challenge and has serious implications.Between 2014 and 2019, a Johns Hopkins study team implemented a wide ranging research recruitment effort in the Baltimore-Washington DC area to enroll participants into two large federally funded dementia care coordination trials.A total of 2,063 study participants were self-or caregiver referred to these projects via referrals from organizations (e.g.religious, health, social service, aging, Medicaid clams) and targeted community outreach (e.g.events, media).Ultimately, 647 ADRD/study partner dyads were enrolled (31%).Outreach and recruitment challenges included stigma, lack of confirmed diagnosis, mistrust of research, and situational crises.The study team adapted enrollment criteria as challenges emerged, and ultimately spent $101,058 on outreach and recruitment to enroll 647 participant dyads.This represents a cost of $156.19 per dyad.This poster will provide background on the research program, detail the comprehensive outreach and recruitment strategies employed and their costs, and discuss best practices for recruiting this population.

FALL PREVENTION I DISABILITY PREVENTION PROGRAM IMPROVES LIFE-SPACE AND FALLS EFFICACY: A RANDOMIZED CONTROLLED TRIAL
Minhui Liu, 1 Qian-Li Xue, 2 Laura Gitlin, 3 Jennifer Wolff, 4 Jack Guralnik, 5 Bruce Leff, 6 and Sarah Szanton, 7 Life-space and falls efficacy are essential to physical independence and consistently predict disabilities.However, it remains unknown whether the CAPABLE, a disability prevention program, improves life-space and falls efficacy in older adults.We evaluated the effects of a home-based disability prevention program on life-space (N=194) and falls efficacy (N=233) among low-income older adults with restricted daily activities.The CAPABLE intervention consists of up to 6 one-hour home visits with an Occupational Therapist (OT), up to 4 one-hour home visits with a Register Nurse (RN), and up to $1300 worth of home repairs, modifications, and assistive devices with a handyman, during four months.Life-space and falls efficacy were measured by the Telephone Assessment of Mobility for homebound older adults and the Tinetti Falls Efficacy Scale at baseline and five months, respectively.Multinomial logistic regression and generalized linear models were used for data analyses.Participants in both samples were, on average, 75 years, predominantly black (86%) and female (85%-86%).Compared to participants in the control group, participants receiving the intervention were more likely to have improved (Odds Ratio [OR]: 2.10, 95% CI: 1.06-4.20)or unchanged overall lifespace (OR: 2.62, 95% CI: 1.10-6.27)vs. decreased overall life-space.Participants who received the intervention also had significantly higher falls efficacy in performing daily activities (exponentiated coefficient: 1.11, 95% CI: 1.04-1.19).Life-space and falls efficacy can be significantly improved by CAPABLE program.These findings provide more evidence for the reasons for the increased physical independence.

FEAR OF FALLING AND COGNITIVE DECLINE IN HEALTHY AGING ADULTS
Rebecca Kraut, 1 and Roee Holtzer, 2 1. Yeshiva University, New York, New York, United States, 2. Yeshiva University, Bronx, New York, United States Fear of Falling (FOF) is common and associated with poor mobility in aging but whether persistence of FOF endorsement influences cognitive decline has not been reported.Here we determined the effect of FOF, measured dichotomously and after accounting for persistence, on decline in global cognitive function (GCF), memory, and attention/executive functions.Older adults with persistent FOF (n=81; mean age=77.63±6.67 yrs; %female=74.1),transient FOF (n=60; mean age=76.93±6.01yrs; %female=61.7), and no FOF (n=286; mean age=75.77±6.42yrs; %female=49.3)were included.FOF was assessed through yes/no responses to "do you have a fear of falling?" at baseline.GCF was assessed using RBANS; memory was assessed using a composite score comprising the immediate and delayed recall index scores from RBANS; attention/executive functions were assessed via a composite score comprising TMT A & B, letter and category fluency tasks, and digit symbol modalities.Cognitive measures were administered annually for up to six years.Linear mixed effects models revealed that persistent FOF was associated with a worse decline in GCF compared to both transient FOF (estimate=0.78,p=.022) and no FOF (estimate=0.75,p=.004).Persistent FOF was also associated with a worse decline in memory compared to those with transient FOF (estimate=0.08,p=.004) and those with no FOF (estimate=0.06,p=.006).Associations between FOF status and decline in attention/executive functions were not significant.These findings demonstrate that persistent FOF is a risk factor for cognitive decline in community-residing older adults.

HOME SAFETY EVALUATION MODEL FOR OLDER ADULTS WITH RECURRENT FALLS
Willy Marcos Valencia, 1 Kimberly Cabrera, 2 and Vincent Hsu, 3 1.Miami VA Healthcare System,Miami,Florida,United States,2. Miami VAMC,Miami,Florida,United States,3. University of Miami Miller School of Medicine,Miami,Florida,United States Recurrent falls are a major threat in older adults.Home environment can be a hazard, but it is potentially modifiable/reversible.In Miami VA, occupational therapists conduct home safety evaluations (HSE) to ascertain the need for modifications to reduce falls risk.We reviewed the cohort of high-risk, recurrent falls patients evaluated at our Falls Prevention Clinic (FPC) between August 2017 to November 2019, to evaluate the impact of HSE.We identified 48 Veterans, age 76.5±6.9 years, of whom 15 (31.3%) reported 1-2 falls/year, 18 (37.5%)reported 3-4 falls/year, and 15 (31.3%) reported ≥5 falls/year.Twenty-eight (58.3%) were offered a HSE.Within these subjects, 74.2% reported falling at least once within their home, 43.8% had fear of falling, 5 (17.9%) had a history of substance or alcohol abuse.We observed that 29 (60.4%) would benefit from the addition of grab bars and 26 (54.2%) could benefit from toilet adjustments.Twelve (25.0%) were recommended to install bed rails.Only 15 (31.3%)Veterans agreed to all recommendations, 25 (52.1%) declined due to preference, and 8 (16.7%) declined for other reasons.Only 8 (16.7%) of these Veterans lived alone.Another factor is that 11 (22.9%)Veterans were renting and 32 (66.7%) owned their homes.Addressing and improving environmental hazards may ameliorate the risk for recurrent falls.Our next steps are to evaluate the extent of home modifications, and the long-term changes in falls/ year.Further research needs to determine the long-term efficacy and cost-effectiveness of HSE, and how it can be more accessible to the community.