How Cognitive Impairment Affects Medication Management in Dental Settings

Abstract Mishandling medications is commonly seen in persons with dementia, which can lead to poor treatment outcome and serious complications. Whether individuals with cognitive impairment can appropriately manage dental-related medication remains unknown, raising a liability concern for dentists who fail to recognize the patients at risk for mishandling their medications. To address this concern, we conducted a study with 51 participants with various cognitive impairment to describe their ability to handle dental-related medications. After cognitive assessment, participants were asked to set up an antibiotics pill-box and use a mouthwash as instructed, and their performance were scored. Number and type of prompts given to facilitate task completion were also documented. Mishandling of dental-related medications was common in participants with cognitive impairment. As expected, participants with poor cognition needed more assistance on handling their medications. Dentists should be aware of this concern and take it into consideration when treatment plan for these individuals. Part of a symposium sponsored by the Oral Health Interest Group.


United States
To further understand social, cultural, and personal predictors of oral health outcomes, this study addressed the relationship between acculturation and subsequent oral health problems and tested the moderating role of neighborhood disorder in such a relationship among older Chinese Americans. The working sample included 2,706 foreign-born community-dwelling older Chinese Americans aged 60 years or older who participated in the Population Study of Chinese Elderly in Chicago at the baseline and the first follow-up.
Stepwise Poisson regression using lagged dependent variable was conducted. Behavioral acculturation was protective against subsequent oral health problems. Residence in Chinatown was associated with an increase in the risk of subsequent oral health problems. The relationship between behavioral acculturation and subsequent oral health problems varied by levels of neighborhood disorder. To reduce oral health-related disease burdens, it is important to consider the role of acculturation and the neighborhood on subsequent oral health problems in practice and policy. Part of a symposium sponsored by the Oral Health Interest Group.

ORAL HEALTH, IMMIGRANT STATUS, AND ADULT CHILDREN'S SUPPORT AMONG CHINESE AMERICAN OLDER ADULTS
Nan Jiang, 1 Bei Wu, 2 and Wei Zhang, 3 1. National University of Singapore,Singapore,New York,Singapore,2. New York University,New York,New York,United States,3. University of Hawaii at Manoa,Honolulu,Hawaii,United States Adult children play an important role in older immigrants' health outcomes. Research has indicated that older adults may benefit from adult children caregivers' support for oral health. However, little is known about children's support for improving oral health for older immigrants. Using the 2018 survey of 430 Chinese older adults age 55 and older in Honolulu, Hawai'i, we examine the associations among immigrant status, adult children's support and perceived oral health for Chinese American older adults. Emotional support from adult children protects the self-rated oral health for the immigrant group, while financial support is linked to fewer oral health problems among the US-born group. Therefore, the current study underlines the importance of investigating different pathways among foreign-born and native-born Chinese older adults with regard to children's support on their oral health outcomes. Part of a symposium sponsored by the Oral Health Interest Group.

. New York University, New York, New York, United States
There is limited information on the impact of cognition function on dental care utilization and costs. This study used the Medicare current beneficiaries survey in 2016 and included 4,268 participants 65+. Dental care utilization and costs were measured by self-report and included preventive and treatment events. Negative binomial regression and generalized linear regression were used to examine the impact of Alzheimer's disease (AD) and related dementia (RD) on dental care utilization and costs. We found that AD was not associated with dental care utilization, but RD was associated with a lower number of total treatment dental care visits (IRR: 0.60; 95% CI: 0.37~0.98). RD was not associated with dental care costs, but AD was associated with higher total dental care costs (estimate: 1.08; 95% CI: 0.14~2.01) and higher out-of-pocket costs (estimate: 1.25; 95% CI: 0.17~2.32). AD and RD had different impacts on different types of dental care utilization and costs. Part of a symposium sponsored by the Oral Health Interest Group. Mishandling medications is commonly seen in persons with dementia, which can lead to poor treatment outcome and serious complications. Whether individuals with cognitive impairment can appropriately manage dental-related medication remains unknown, raising a liability concern for dentists who fail to recognize the patients at risk for mishandling their medications. To address this concern, we conducted a study with 51 participants with various cognitive impairment to describe their ability to handle dental-related medications. After cognitive assessment, participants were asked to set up an antibiotics pill-box and use a mouthwash as instructed, and their performance were scored. Number and type of prompts given to facilitate task completion were also documented. Mishandling of dental-related medications was common in participants with cognitive impairment. As expected, participants with poor cognition needed more assistance on handling their medications. Dentists should be aware of this concern and take it into consideration when treatment plan for these individuals. Part of a symposium sponsored by the Oral Health Interest Group.

TECHNOLOGY-BASED APPLICATIONS FOR THE ASSESSMENT AND MANAGEMENT OF ALZHEIMER'S DISEASE AND RELATED DISORDERS Chair: Lauren Massimo Discussant: George Demiris
Over the last decade, technological advances have made it possible for people to access health information right at their fingertips. Indeed, technology-based applications (apps) have been developed to tackle a wide range of health-related issues, including Alzheimer's disease and related disorders (ADRD). As such, there is a critical need to develop and test effective dementia apps that can ultimately be converted in to scalable programs. In this interdisciplinary symposium, we will discuss the development and testing of novel apps for the assessment and management of ADRD. The first session will discuss the development of an online money management credit card task to assess cognitively vulnerable older adults who are at risk for making poor financial decisions. The second session will describe the development and psychometric testing properties of a mobile app to detect the earliest features of preclinical Alzheimer's disease. The third session will highlight findings from a study testing a smartphone-based prompting app to improve everyday task completion in persons with mild cognitive impairment and mild dementia. The last session will share findings from a study testing a mobile app to increase goal-directed behavior and reduce apathy in persons with dementia. Together, these presentations describe how technology-based applications can be used to assess and manage cognitive and behavioral symptoms of ADRD.

DEVELOPMENT OF THE ONLINE MONEY MANAGEMENT CREDIT CARD TASK
Preeti Sunderaraman, 1 Ziqian Dong, 2 Santhoshkumar Sampath, 2 Silvia Chapman, 3 Jillian Joyce, 1 Yaakov Stern, 1 and Stephanie Cosentino, 4 1. Columbia University,New York,New York,United States,2. New York Institute of Technology,New York,New York,United States,3. Columbia University,New York,Pennsylvania,United States,4. Columbia University Medical Center,New York,New York,United States Older adults (OAs), a wealthy but vulnerable segment of our population, are at risk to make compromised financial decisions. Evidence suggests that OAs increasingly use technology to perform everyday financial transactions, such as to manage their credit card statements. However, current tools are lacking in terms of assessing how older adults navigate and handle the online financial milieu. We will discuss the development of a novel, simulated online money management (OMM) credit card statement task. OMM examines OAs performance on several indices including reaction time, nature and frequency of errors, and their ability to comprehend and trouble shoot problems. Psychometric properties related to the reliability and validity will be discussed. Ultimately, by examining the longitudinal performance of OMM in OAs, we can better characterize the natural course of OMM. Such an approach will enable clinicians to accurately and objectively examine OMM and identify those at risk for making financial errors. This study investigates the psychometric properties of the mobile cognitive app performance platform (mCAPP), designed to detect memory changes associated with preclinical Alzheimer's Disease (AD). The mCAPP memory task includes learning and matching hidden card pairs and incorporates increasing memory load, pattern separation features, and spatial memory. Participants included 30 older adults with normal cognition. They completed the mCAPP, paper and pencil neuropsychological tests and a subset completed a high-resolution structural MRI. The majority of participants found the difficulty level of the mCAPP game to be "just right". Accuracy on the mCAPP correlated with performance on memory and executive measures, while speed of performance on the mCAPP correlated with performance on attention and executive function measures. Longer trial duration correlated with measures of the parahippocampal cortex. The relationship of mCAPP variables with molecular biomarkers, at-home and burst testing, and development of additional cognitive measures will also be discussed.

SMARTPROMPT REMINDER APPLICATION IMPROVES EVERYDAY TASK COMPLETION AND REDUCES INEFFICIENT BEHAVIORS
Hackett Katherine, Sarah Lehman, Ross Drivers, Matthew Ambrogi, Likhon Gomes, Chiu Tan, and