Motor Behavior Changes Are Predictive of Acute Events in Skilled Nursing

Abstract Background: Common acute medical conditions among older adults with dementia in skilled nursing include falls, delirium, and pneumonia. This study utilized a sensor technology to examine how motor behaviors may predict these acute events. Methods: Radio frequency identification (RFID) technology continuously measured time and distance travelled, gait speed, and continuous walking with little/no breaks (paths) across 3 long-term facilities for up to 1 year (N=51). Change point analysis estimates the probability of whether a sudden change occurred and provides the location of the change point (in days prior to the event) in a time series model. Results: Gait speed had very low probability to detect a change point across all events (22 falls, 10 delirium and 8 pneumonia). Sensitivity estimates ranged from 63% (number of paths) to 90% (distance travelled) for a fall; 37.5% (number of paths) to 100% (rest of the motor behaviors) for pneumonia. Except for gait speed, all other motor behaviors had high probability (100%) to detect a delirium change point. There was intra-individual variability in the location of the change points (mean of 10 days). Linear regression models for time and distance travelled using baseline predictors of age, ethnicity, gait and balance explained 89% and 90% of the variance in change point locations. Conclusions: Prior to an acute event there is a significant change in motor behavior, suggesting these are an early signal that may be used to prevent a fall or provide for the earlier recognition and treatment of delirium and pneumonia.


ASSOCIATIONS BETWEEN ACTIGRAPHY-ASSESSED HEALTH BEHAVIORS AND COGNITIVE PERFORMANCE IN OLDER ADULTS
Alex Laffer,1 Hilary Hicks,1 Genna Losinski,1 and Amber Watts,1, University of Kansas, Lawrence, Kansas, United States Lifestyle behaviors are important determinants of healthy brain aging.Research has not fully explored how sleep quality and physical activity may differentially influence specific domains of cognitive function.The present study aimed to estimate the relative influence of sleep quality and physical activity on cognitive performance in three domains in a sample of older adults.Older adults (ages 60-89, M = 74.74)without cognitive impairment (N= 160) wore an accelerometer for 7 days in a free-living environment.We used average vector magnitude counts per minute to measure total physical activity (TPA), and average wake after sleep onset (WASO) to measure sleep quality.We created cognitive composite scores (executive function, attention, and verbal memory) from neuropsychological data using confirmatory factor analysis.We regressed cognitive scores onto TPA and WASO with age and education entered as covariates.Higher amounts of physical activity and better sleep quality were associated with better executive function (R2 = 20.3%,F (4, 155) = 11.12,p < .001).Neither physical activity nor sleep quality was associated with verbal memory or attention.Results suggest that more physical activity and improved ability to stay asleep may benefit executive function, but not other cognitive domains.Future studies should clarify the interaction and mechanisms of action between health behaviors and cognitive performance in older adults.

INTERNET USE AND COGNITIVE FUNCTIONING IN LATER LIFE: FOCUS ON ASYMMETRIC EFFECTS AND CONTEXTUAL FACTORS
Yijung Kim, and Sae Hwang Han, 1.The University of Texas at Austin, Austin, Texas, United States Despite the emerging literature linking information communicative technology (ICT) use and cognitive functioning in later life, whether the association varies as a function of social environment and birth cohort remain an open question.Using nine waves of panel data from the U.S. Health andRetirement Study (2002-2018), we examined withinperson asymmetric effects of transitioning into and out of Internet use on cognitive functioning, and whether the associations vary depending on living arrangement and across birth cohorts.Results from the multilevel models indicated that transitioning into Internet use was associated with improved cognitive functioning at a given wave and decelerated cognitive decline over time.Similarly, ceasing to use the Internet was associated with worse cognitive functioning and accelerated cognitive decline.Further, such linkages between Internet use and cognitive functioning were moderated by living arrangement and birth cohort.The detrimental effect of ceasing Internet use was worse for those older adults who live alone.Transitioning into and out of Internet use was unrelated to changes in cognitive functioning among recent HRS cohorts, namely, the War Babies (b:1942-47) and Early Baby Boomers (b:1948-53).These findings highlight the interplay between technology, social environment, and cognitive functioning in later life.The salubrious effects of adopting an ICT technology, such as the Internet, as well as deleterious effects of ceasing to use such technology, underscores the importance of promoting digital literacy and access to ICT technologies among the older adult population.Background: Common acute medical conditions among older adults with dementia in skilled nursing include falls, delirium, and pneumonia.This study utilized a sensor technology to examine how motor behaviors may predict these acute events.Methods: Radio frequency identification (RFID) technology continuously measured time and distance travelled, gait speed, and continuous walking with little/no breaks (paths) across 3 long-term facilities for up to 1 year (N=51).Change point analysis estimates the probability of whether a sudden change occurred and provides the location of the change point (in days prior to the event) in a time series model.Results: Gait speed had very low probability to detect a change point across all events (22 falls, 10 delirium and 8 pneumonia).Sensitivity estimates ranged from 63% (number of paths) to 90% (distance travelled) for a fall; 37.5% (number of paths) to 100% (rest of the motor behaviors) for pneumonia.Except for gait speed, all other motor behaviors had high probability (100%) to detect a delirium change point.There was intra-individual variability in the location of the change points (mean of 10 days).Linear regression models for time and distance travelled using baseline predictors of age, ethnicity, gait and balance explained 89% and 90% of the variance in change point locations.Conclusions: Prior to an acute event there is a significant change in motor behavior, suggesting these are an early signal that may be used to prevent a fall or provide for the earlier recognition and treatment of delirium and pneumonia.Decades of research have documented the negative effects of caregiving on unpaid caregivers.Caregivers are more likely to suffer from high levels of stress and anxiety, and caregivers of older adults with dementia are at especially high risk.Mindfulness Therapy (MT) is a promising, non-pharmacological technique with proven efficacy and effectiveness in managing stress and anxiety in diverse populations.Mindfulness Coach is an m-health delivered mindfulness therapy intervention developed by the Veterans Affairs National Center for PTSD.The objective of this paper is to report the preliminary efficacy of an 8-week pilot trial of mHealth-delivered mindfulness therapy to alleviate anxiety and caregiver stress in caregivers of persons with dementia.Sixty caregivers of patients with mild cognitive impairment or dementia were recruited to participate in this single group pre-post design study.After receiving an orientation to using the app, participants were instructed to use the app daily to learn about and practice mindfulness skills.At the end of the 8 weeks, there was a significant reduction between baseline anxiety on the Hospital Anxiety and Depression Scale Anxiety subscale (mean = 14.45,SD = 3.36) 15.42, SD = 3.12) and 8 weeks (mean = (t(55)=2.6,p=.012) and perceived stress measured by the perceived stress scale at baseline (mean = 23.59,SD = 3.99) and 8 weeks (mean = 21.12,SD = 3.09), (t(56)=5.94,p<.001).This study offers preliminary evidence that mHealth Mindfulness Therapy strategies may help caregivers manage the stress and anxiety associated with caregiving.

THE LONG AND WINDING ROAD: EARLY YEARS OF THE ACCREDITATION FOR GERONTOLOGY EDUCATION COUNCIL
Chair: Robert Maiden Co-Chair: Donna Schafer The long road of establishing an accreditation entity began in August 2010 when the AGHE Accreditation Task Force was convened.After numerous meetings complete with loud and vigorous debates, AGEC, the Accreditation for Gerontology Education Council emerged in 2016.Over the subsequent years, the Standards hit the hard road of reality leading to various revisions to the Handbook.The symposium's first presentation concerns the history of AGEC and its further development into an independent entity.The key purpose of AGEC is assuring gerontology programs educational quality and enhancement governed by the principle of self-evaluation and peer review that engenders trust.The next presentation discusses the marketing aspect of AGEC built on getting feedback from the public.One of the outcomes of conducting focus groups and surveying the public is the discovery that prospective students really see the value of accreditation.The penultimate presentation focuses on refinements to procedures alluded to in the first presentation in response to the feedback received in meeting with institutions and faculty about what accreditation offers to students, stake-holders, and ultimately the older adults served by the graduates in the work force.The key goal is to clarify the expectations and simplify the application process.On no other issue has more time been spent than on the assessment of students' competency.Our last presentation explains competency-based education consisting of well-articulated student learning outcome measures that are consonant with the program's mission that lead to "closing the loop" of continuous and durable improvements in the learning environment.

REFINING THE LOOP OF CONTINUOUS IMPROVEMENT
Robert Maiden, 1 and Jan Abushakrah, 2 1. Alfred University,Alfred,New York,United States,2. Portland Community College,Portland,Oregon,United States Academic assessment of student competency is essential to measure learning within a gerontology program.In its self-evaluation, a program must assess its student learning outcomes.JoAnn Damron-Rodriguez et al. (2019, p. 423) proposed a systematic approach that has several levels.The key is to utilize a competency-based education model.Moreover, to satisfy workforce goals the gerontology program must adopt the AGHE competencies that reflect the knowledge, skills, and attitudes necessary to serve older adults at an acceptable level of care.The next step involves generating well-articulated quantitative or qualitative measures of student learning outcomes (SLOs) consistent with the program's mission statement that include twelve competency domains.SLO measures include test grades, assignments, projects, portfolios, field experiences, essay questions, multiple choice items, and so on.The program's enhancement loop requires the evaluation of SLOs, faculty discussion of them, and a continuous modification cycle "closing the loop" to reach the program's goals.

GOOD TROUBLE ALONG THE WINDING ROAD: DISRUPTION AND ACCOMPLISHMENT
Harvey Sterns, 1 and Joseph Ruby, 2 1.The University of Akron,Akron,Ohio,United States,2. Joe Ruby Consulting,Akron,Ohio,United States The establishment of a accreditation body for gerontology degree programs was seen as disruptive.Many key leaders were against creating such a body and wanted this to be delayed or to never happen.In 2012, the AGHE Mary (Libbey) Bowen, 1 Meredeth Rowe, 2 Pamela Cacchione, 3 and Ming Ji, 2 1.University of Delaware School of Nursing & Cpl.Michael J.