Soo Borson | University of Washington (original) (raw)

Papers by Soo Borson

Research paper thumbnail of Estimating Progression Rates Across the Spectrum of Alzheimer’s Disease for Amyloid-Positive Individuals Using National Alzheimer’s Coordinating Center Data

Neurology and Therapy, Aug 24, 2021

Research paper thumbnail of Impairment Primary Care Screening for Dementia and Mild Cognitive

In their Commentary, Dr Brayne and colleagues 1 raise many critical issues regarding the need to ... more In their Commentary, Dr Brayne and colleagues 1 raise many critical issues regarding the need to identify effective methods to screen for dementia. We suggest that this include detection of the mild cognitive impairment (MCI) syndrome, where there is objective decline in cognitive functioning. Longitudinal clinical studies indicate that participants with amnestic MCI have a substantially increased rate of progression to clinically probable Alzheimer disease. 2 As the authors point out, it is extremely unusual to find reversible causes of dementia. However, many potentially reversible factors can contribute to MCI with cognitive performance that is worse than expected as a result of aging alone, such as medical illness, depression, medication adverse effects, or cardiovascular factors. Many of these may be amenable to intervention if a patient screens positive on routine testing. Moreover, nonpharmacological therapies such as psychosocial interventions have been reported as effective in improving cognitive performance in aging persons. 3 A negative screen for MCI can be used to reassure individuals who are concerned about their self-perceived decline in cognitive performance and confirm that they are most likely experiencing age-related changes, rather than the beginnings of Alzheimer disease or another dementia. Two of the larger studies of normal aging vs MCI 4,5 have demonstrated benefits derived from screening asymptomatic individuals in a primary care setting. In both studies, more than 90% of patients identified with MCI had a progressive disorder as the underlying cause of the cognitive impairment. The potential for intervention and delaying disease progression in most of these patients argues for detection as early as possible, in the MCI stage, so that the underlying cause of the cognitive impairment can be treated when possible. If one applied to diabetes mellitus the approach of not screening at-risk asymptomatic individuals and instead waited until symptoms developed, many of these symptoms (including neuropathy, retinopathy, nephropathy, and cerebrovascular disease) would not reverse with treatment. This would be considered unacceptable clinical practice for diabetes. We do not think that Alzheimer disease should be viewed differently, given that there is at least some substantive evidence that at-risk individuals can be diagnosed in the earliest stages and that potentially reversible factors contributing to cognitive performance declines can be further investigated and treated.

Research paper thumbnail of Factors associated with high intensity of end‐of‐life care for decedents with dementia in a Medicare Advantage plan

Alzheimer's & Dementia

BackgroundThere are limited data on end‐of‐life care (EOL) for decedents with dementia enrolled i... more BackgroundThere are limited data on end‐of‐life care (EOL) for decedents with dementia enrolled in Medicare Advantage plans. The purpose of this descriptive analysis is to compare socio‐demographic and clinical characteristics and patterns of healthcare utilization for decedents who were hospitalized in the last 30 days of life versus those who were not.MethodsData were extracted from electronic health records (EHR) of individuals aged 65+ who had at least one coded ADRD diagnosis and died in 2018‐2019. Decedents with one or more hospital stays in the last 30 days of life were categorized as receiving high‐intensity EOL care (n = 6299, 45%); those with no hospitalizations were classified as receiving low‐intensity EOL care (n = 7571, 55%). We compared socio‐demographic and clinical characteristics and healthcare utilization, including life care planning (LCP) and palliative and hospice care between the two cohorts.ResultsThe high‐intensity cohort was minimally younger (85±7.6 vs. 86...

Research paper thumbnail of The national public health response to Alzheimer's disease and related dementias: Origins, evolution, and recommendations to improve early detection

Alzheimer's & Dementia

Research paper thumbnail of Community health workers and care of older adults: How to learn what we need to know

Journal of the American Geriatrics Society

This editorial comments on the article by Kennedy et al. in this issue.

Research paper thumbnail of Modifying the Mini-Cog to Screen for Cognitive Impairment in Nonliterate Individuals

International Journal of Alzheimer's Disease

Objectives. The Mini-Cog, a rapid, valid, and reliable screening tool for cognitive impairment, c... more Objectives. The Mini-Cog, a rapid, valid, and reliable screening tool for cognitive impairment, consists of 3-word recall and an executive clock drawing test (CDT). However, CDT requires at least basic literacy and cultural exposure to analog clocks, conditions not met in many population groups around the world. We developed a modification of the Mini-Cog (MMC) for use with nonliterate and literate individuals. Methods. Participants were adults (≥60 years) with no neurological diagnosis, with known cognitive impairment due to stroke, Parkinsonism, traumatic brain injury, or Alzheimer’s disease, and whose family members were able to read and write. We replaced the CDT with two tasks of everyday life: a serial subtraction task or a multistep performance task. Family members rated the acceptability and feasibility of the Mini-Cog versions using a 6-point scale and completed a proxy-rated cognitive staging tool, the Dementia Severity Rating Scale (DSRS). Spearman’s rho, Mann-Whitney U ,...

Research paper thumbnail of Dementia Care Partner Self-Care: A Framework to Illustrate Mechanisms of Facilitators and Barriers

Innovation in Aging

Dementia care partner (CP) self-care is an important intervention target to enhance resilience an... more Dementia care partner (CP) self-care is an important intervention target to enhance resilience and reduce risk of negative physical and psychological outcomes, such as illness, functional decline, depression and anxiety. Yet few studies have explored CP perceptions of what helps vs prevents them from consistently engaging in self-care activities. This exploratory study examined data from 100 semi-structured CP interviews on the barriers and facilitators to self-care. Inductive thematic analysis identified multiple facilitators and barriers that can be characterized as actual (did affect self-care) or potential (would affect self-care). CP capacity to participate in self-care activities was influenced by internal (e.g. setting boundaries) or external (e.g. social support) factors. We developed a framework to illustrate these mechanisms and guide interventions for optimizing self-care behaviors.

Research paper thumbnail of Program of Intensive Support in Emergency Departments for Care Partners of Cognitively Impaired Patients: Protocol for a Multisite Randomized Controlled Trial

JMIR Research Protocols

Background Older adults with cognitive impairment have more emergency department visits and 30-da... more Background Older adults with cognitive impairment have more emergency department visits and 30-day readmissions and are more likely to die after visiting the emergency department than people without cognitive impairment. Emergency department providers frequently do not identify cognitive impairment. Use of cognitive screening tools, along with better understanding of root causes for emergency department visits, could equip health care teams with the knowledge needed to develop individually tailored care management strategies for post–emergency department care. By identifying and directly addressing patients’ and informal caregivers’ (or care partners’) psychosocial and health care needs, such strategies could reduce the need for repeat acute care. We have used the terms “caregiver” and “care partner” interchangeably. Objective We aimed to describe the protocol for a randomized controlled trial of a new care management intervention, the Program of Intensive Support in Emergency Depar...

Research paper thumbnail of Impact of financial distress on perception of preparedness, burden and quality of life in caregivers of persons living with dementia

Journal of the American Geriatrics Society, 2021

Research paper thumbnail of Major depression and related disorders

Research paper thumbnail of Knowledge and Attitudes Concerning Aducanumab Among Older Americans After FDA Approval for Treatment of Alzheimer Disease

JAMA Network Open, 2022

Dr Borson reported serving as an author of an information sheet prepared by the American Geriatri... more Dr Borson reported serving as an author of an information sheet prepared by the American Geriatrics Society for consumers and patients regarding aducanumab. No other disclosures were reported.

Research paper thumbnail of A mixed‐methods evaluation of home‐based primary care in dementia within an integrated system

Journal of the American Geriatrics Society, 2021

BackgroundNo prior studies have examined the effects of home‐based primary care (HBPC) in persons... more BackgroundNo prior studies have examined the effects of home‐based primary care (HBPC) in persons living with dementia (PLWD), within an ecosystem of serious illness care in an integrated healthcare system. Our objectives were to compare the characteristics of PLWD receiving HBPC and their hospital utilization and end‐of‐life care, with those of a matched comparison group, and to understand the experiences of family caregivers of PLWD receiving HBPC.MethodsThis mixed‐methods study used a retrospective observational cohort design with PLWD receiving HBPC (n = 287) from 2015 to 2020 and a strata‐matched comparison group (n = 861), and qualitative phone interviews with 16 HBPC family caregivers in 2020. Inverse probability of treatment weighting propensity score‐adjusted models were used to compare time‐to‐first hospital‐based utilization and, for decedents, home palliative and hospice care and place of death. Care experience was captured through caregiver interviews.ResultsPatients re...

Research paper thumbnail of Rationale for Early Diagnosis of Mild Cognitive Impairment (MCI) Supported by Emerging Digital Technologies

The Journal of Prevention of Alzheimer's Disease, 2020

Disease-modifying pharmacotherapies for Alzheimer’s Disease (AD) are currently in late-stage clin... more Disease-modifying pharmacotherapies for Alzheimer’s Disease (AD) are currently in late-stage clinical development; once approved, new healthcare infrastructures and services, including primary healthcare, will be necessary to accommodate a huge demand for early and large-scale detection of AD. The increasing global accessibility of digital consumer electronics has opened up new prospects for early diagnosis and management of mild cognitive impairment (MCI) with particular regard to AD. This new wave of innovation has spurred research in both academia and industry, aimed at developing and validating a new “digital generation” of tools for the assessment of the cognitive performance. In light of this paradigm shift, an international working group (the Global Advisory Group on Future MCI Care Pathways) convened to elaborate on how digital tools may be optimally integrated in screening-diagnostic pathways of AD The working group developed consensus perspectives on new algorithms for lar...

Research paper thumbnail of Incident Dementia, Glycated Hemoglobin (HbA1c) Levels, and Potentially Preventable Hospitalizations in People Aged 65 and Older With Diabetes

The Journals of Gerontology: Series A, 2021

BackgroundThis study was aimed to determine whether incident dementia and HbA1c levels are associ... more BackgroundThis study was aimed to determine whether incident dementia and HbA1c levels are associated with increased rates of potentially preventable hospitalizations (PPHs) in persons with diabetes.MethodA total of 565 adults aged 65+ ever treated for diabetes were enrolled from Adult Changes in Thought study. PPHs were from principal discharge diagnoses and included diabetes PPH (dPPH), respiratory PPH (rPPH), urinovolemic PPH (uPPH), cardiovascular PPH, and other PPH. Poisson generalized estimating equations estimated rate ratios (RRs) and 95% confidence intervals (CIs) for the associations between dementia or HbA1c measures and rate of PPHs.ResultsA total of 562 individuals contributed 3 602 dementia-free years, and 132 individuals contributed 511 dementia follow-up years. One hundred twenty-eight (23%) dementia-free individuals had 210 PPH admissions and a crude rate of 58 per 1 000 person-years, while 55 (42%) individuals with dementia had 93 PPH admissions and a crude rate of...

Research paper thumbnail of Early Detection of Mild Cognitive Impairment (MCI) in Primary Care

The Journal of Prevention of Alzheimer's Disease, 2020

Mild cognitive impairment (MCI) is significantly misdiagnosed in the primary care setting due to ... more Mild cognitive impairment (MCI) is significantly misdiagnosed in the primary care setting due to multi-dimensional frictions and barriers associated with evaluating individuals’ cognitive performance. To move toward large-scale cognitive screening, a global panel of clinicians and cognitive neuroscientists convened to elaborate on current challenges that hamper widespread cognitive performance assessment. This report summarizes a conceptual framework and provides guidance to clinical researchers and test developers and suppliers to inform ongoing refinement of cognitive evaluation. This perspective builds upon a previous article in this series, which outlined the rationale for and potentially against efforts to promote widespread detection of MCI. This working group acknowledges that cognitive screening by default is not recommended and proposes large-scale evaluation of individuals with a concern or interest in their cognitive performance. Such a strategy can increase the likelihoo...

Research paper thumbnail of Reply to: MoCA Test Mandatory Training and Certification: What Is the Purpose?

Journal of the American Geriatrics Society, 2019

Research paper thumbnail of Behavioral Markers of Resilience in Care Partners of Persons with Dementia: A Thematic Analysis from a Scoping Review

Innovation in Aging, 2019

Caring for a person with dementia (PWD) requires commitment, flexibility, and resilience - the ab... more Caring for a person with dementia (PWD) requires commitment, flexibility, and resilience - the ability to endure and recover from stressors that arise during the caring process. However, it is unknown what behaviors can indicate resilience in care partners (CPs) of PWDs. We examined 46 peer-reviewed articles (1990 to 2018) that included measures or definitions of resilience in CPs of PWDs. Our goal is to identify resilience-related behaviors and create a behavior-based model/framework for CPs of PWDs. Three major themes emerged: (1) Problem-response behaviors (problem-identifying, problem-solving, problem-distancing, learning, and reflection); (2) self-growth behaviors (self-care, creative/spiritual activities, and developing/maintaining meaningful social relationships); (3) help-related behaviors (help-seeking and help-receiving). These findings informed the development of a behavior-based Care Partner Resilience (CPR) measure. Future steps in this research include evaluating to wh...

Research paper thumbnail of Reducing Barriers to Mental Health Care: Bringing Evidence‐Based Psychotherapy Home

Journal of the American Geriatrics Society, 2019

OBJECTIVESBarriers to treatment for depression and anxiety are prevalent among older adults and c... more OBJECTIVESBarriers to treatment for depression and anxiety are prevalent among older adults and caregivers living in the community. We designed and implemented an evidence‐based psychotherapy program to reduce obstacles to care.DESIGNA practice improvement initiative providing no‐fee evidence‐based mental health care at home in clients' primary languages.SETTINGIndependence at Home, a community service of SCAN Health Plan in Southern California.PARTICIPANTSDiverse older adults and adult caregivers of older people with age‐related disability (mainly dementia).INTERVENTIONRedesign of an existing supportive counseling program to improve access to validated models of psychotherapy for depression and anxiety.MEASUREMENTSWe describe program content, phases of development, equity in participation from referral to program completion, clinical outcomes, and estimated direct program delivery costs.RESULTSInsights successfully served demographically diverse clients experiencing a broad ran...

Research paper thumbnail of Potentially Un-Avoidable Hospitalizations in Dementia: An Inside Story

Innovation in Aging, 2018

Research paper thumbnail of Operationalizing the Concept of Resilience for Dementia Caregiving

Innovation in Aging, 2018

Research paper thumbnail of Estimating Progression Rates Across the Spectrum of Alzheimer’s Disease for Amyloid-Positive Individuals Using National Alzheimer’s Coordinating Center Data

Neurology and Therapy, Aug 24, 2021

Research paper thumbnail of Impairment Primary Care Screening for Dementia and Mild Cognitive

In their Commentary, Dr Brayne and colleagues 1 raise many critical issues regarding the need to ... more In their Commentary, Dr Brayne and colleagues 1 raise many critical issues regarding the need to identify effective methods to screen for dementia. We suggest that this include detection of the mild cognitive impairment (MCI) syndrome, where there is objective decline in cognitive functioning. Longitudinal clinical studies indicate that participants with amnestic MCI have a substantially increased rate of progression to clinically probable Alzheimer disease. 2 As the authors point out, it is extremely unusual to find reversible causes of dementia. However, many potentially reversible factors can contribute to MCI with cognitive performance that is worse than expected as a result of aging alone, such as medical illness, depression, medication adverse effects, or cardiovascular factors. Many of these may be amenable to intervention if a patient screens positive on routine testing. Moreover, nonpharmacological therapies such as psychosocial interventions have been reported as effective in improving cognitive performance in aging persons. 3 A negative screen for MCI can be used to reassure individuals who are concerned about their self-perceived decline in cognitive performance and confirm that they are most likely experiencing age-related changes, rather than the beginnings of Alzheimer disease or another dementia. Two of the larger studies of normal aging vs MCI 4,5 have demonstrated benefits derived from screening asymptomatic individuals in a primary care setting. In both studies, more than 90% of patients identified with MCI had a progressive disorder as the underlying cause of the cognitive impairment. The potential for intervention and delaying disease progression in most of these patients argues for detection as early as possible, in the MCI stage, so that the underlying cause of the cognitive impairment can be treated when possible. If one applied to diabetes mellitus the approach of not screening at-risk asymptomatic individuals and instead waited until symptoms developed, many of these symptoms (including neuropathy, retinopathy, nephropathy, and cerebrovascular disease) would not reverse with treatment. This would be considered unacceptable clinical practice for diabetes. We do not think that Alzheimer disease should be viewed differently, given that there is at least some substantive evidence that at-risk individuals can be diagnosed in the earliest stages and that potentially reversible factors contributing to cognitive performance declines can be further investigated and treated.

Research paper thumbnail of Factors associated with high intensity of end‐of‐life care for decedents with dementia in a Medicare Advantage plan

Alzheimer's & Dementia

BackgroundThere are limited data on end‐of‐life care (EOL) for decedents with dementia enrolled i... more BackgroundThere are limited data on end‐of‐life care (EOL) for decedents with dementia enrolled in Medicare Advantage plans. The purpose of this descriptive analysis is to compare socio‐demographic and clinical characteristics and patterns of healthcare utilization for decedents who were hospitalized in the last 30 days of life versus those who were not.MethodsData were extracted from electronic health records (EHR) of individuals aged 65+ who had at least one coded ADRD diagnosis and died in 2018‐2019. Decedents with one or more hospital stays in the last 30 days of life were categorized as receiving high‐intensity EOL care (n = 6299, 45%); those with no hospitalizations were classified as receiving low‐intensity EOL care (n = 7571, 55%). We compared socio‐demographic and clinical characteristics and healthcare utilization, including life care planning (LCP) and palliative and hospice care between the two cohorts.ResultsThe high‐intensity cohort was minimally younger (85±7.6 vs. 86...

Research paper thumbnail of The national public health response to Alzheimer's disease and related dementias: Origins, evolution, and recommendations to improve early detection

Alzheimer's & Dementia

Research paper thumbnail of Community health workers and care of older adults: How to learn what we need to know

Journal of the American Geriatrics Society

This editorial comments on the article by Kennedy et al. in this issue.

Research paper thumbnail of Modifying the Mini-Cog to Screen for Cognitive Impairment in Nonliterate Individuals

International Journal of Alzheimer's Disease

Objectives. The Mini-Cog, a rapid, valid, and reliable screening tool for cognitive impairment, c... more Objectives. The Mini-Cog, a rapid, valid, and reliable screening tool for cognitive impairment, consists of 3-word recall and an executive clock drawing test (CDT). However, CDT requires at least basic literacy and cultural exposure to analog clocks, conditions not met in many population groups around the world. We developed a modification of the Mini-Cog (MMC) for use with nonliterate and literate individuals. Methods. Participants were adults (≥60 years) with no neurological diagnosis, with known cognitive impairment due to stroke, Parkinsonism, traumatic brain injury, or Alzheimer’s disease, and whose family members were able to read and write. We replaced the CDT with two tasks of everyday life: a serial subtraction task or a multistep performance task. Family members rated the acceptability and feasibility of the Mini-Cog versions using a 6-point scale and completed a proxy-rated cognitive staging tool, the Dementia Severity Rating Scale (DSRS). Spearman’s rho, Mann-Whitney U ,...

Research paper thumbnail of Dementia Care Partner Self-Care: A Framework to Illustrate Mechanisms of Facilitators and Barriers

Innovation in Aging

Dementia care partner (CP) self-care is an important intervention target to enhance resilience an... more Dementia care partner (CP) self-care is an important intervention target to enhance resilience and reduce risk of negative physical and psychological outcomes, such as illness, functional decline, depression and anxiety. Yet few studies have explored CP perceptions of what helps vs prevents them from consistently engaging in self-care activities. This exploratory study examined data from 100 semi-structured CP interviews on the barriers and facilitators to self-care. Inductive thematic analysis identified multiple facilitators and barriers that can be characterized as actual (did affect self-care) or potential (would affect self-care). CP capacity to participate in self-care activities was influenced by internal (e.g. setting boundaries) or external (e.g. social support) factors. We developed a framework to illustrate these mechanisms and guide interventions for optimizing self-care behaviors.

Research paper thumbnail of Program of Intensive Support in Emergency Departments for Care Partners of Cognitively Impaired Patients: Protocol for a Multisite Randomized Controlled Trial

JMIR Research Protocols

Background Older adults with cognitive impairment have more emergency department visits and 30-da... more Background Older adults with cognitive impairment have more emergency department visits and 30-day readmissions and are more likely to die after visiting the emergency department than people without cognitive impairment. Emergency department providers frequently do not identify cognitive impairment. Use of cognitive screening tools, along with better understanding of root causes for emergency department visits, could equip health care teams with the knowledge needed to develop individually tailored care management strategies for post–emergency department care. By identifying and directly addressing patients’ and informal caregivers’ (or care partners’) psychosocial and health care needs, such strategies could reduce the need for repeat acute care. We have used the terms “caregiver” and “care partner” interchangeably. Objective We aimed to describe the protocol for a randomized controlled trial of a new care management intervention, the Program of Intensive Support in Emergency Depar...

Research paper thumbnail of Impact of financial distress on perception of preparedness, burden and quality of life in caregivers of persons living with dementia

Journal of the American Geriatrics Society, 2021

Research paper thumbnail of Major depression and related disorders

Research paper thumbnail of Knowledge and Attitudes Concerning Aducanumab Among Older Americans After FDA Approval for Treatment of Alzheimer Disease

JAMA Network Open, 2022

Dr Borson reported serving as an author of an information sheet prepared by the American Geriatri... more Dr Borson reported serving as an author of an information sheet prepared by the American Geriatrics Society for consumers and patients regarding aducanumab. No other disclosures were reported.

Research paper thumbnail of A mixed‐methods evaluation of home‐based primary care in dementia within an integrated system

Journal of the American Geriatrics Society, 2021

BackgroundNo prior studies have examined the effects of home‐based primary care (HBPC) in persons... more BackgroundNo prior studies have examined the effects of home‐based primary care (HBPC) in persons living with dementia (PLWD), within an ecosystem of serious illness care in an integrated healthcare system. Our objectives were to compare the characteristics of PLWD receiving HBPC and their hospital utilization and end‐of‐life care, with those of a matched comparison group, and to understand the experiences of family caregivers of PLWD receiving HBPC.MethodsThis mixed‐methods study used a retrospective observational cohort design with PLWD receiving HBPC (n = 287) from 2015 to 2020 and a strata‐matched comparison group (n = 861), and qualitative phone interviews with 16 HBPC family caregivers in 2020. Inverse probability of treatment weighting propensity score‐adjusted models were used to compare time‐to‐first hospital‐based utilization and, for decedents, home palliative and hospice care and place of death. Care experience was captured through caregiver interviews.ResultsPatients re...

Research paper thumbnail of Rationale for Early Diagnosis of Mild Cognitive Impairment (MCI) Supported by Emerging Digital Technologies

The Journal of Prevention of Alzheimer's Disease, 2020

Disease-modifying pharmacotherapies for Alzheimer’s Disease (AD) are currently in late-stage clin... more Disease-modifying pharmacotherapies for Alzheimer’s Disease (AD) are currently in late-stage clinical development; once approved, new healthcare infrastructures and services, including primary healthcare, will be necessary to accommodate a huge demand for early and large-scale detection of AD. The increasing global accessibility of digital consumer electronics has opened up new prospects for early diagnosis and management of mild cognitive impairment (MCI) with particular regard to AD. This new wave of innovation has spurred research in both academia and industry, aimed at developing and validating a new “digital generation” of tools for the assessment of the cognitive performance. In light of this paradigm shift, an international working group (the Global Advisory Group on Future MCI Care Pathways) convened to elaborate on how digital tools may be optimally integrated in screening-diagnostic pathways of AD The working group developed consensus perspectives on new algorithms for lar...

Research paper thumbnail of Incident Dementia, Glycated Hemoglobin (HbA1c) Levels, and Potentially Preventable Hospitalizations in People Aged 65 and Older With Diabetes

The Journals of Gerontology: Series A, 2021

BackgroundThis study was aimed to determine whether incident dementia and HbA1c levels are associ... more BackgroundThis study was aimed to determine whether incident dementia and HbA1c levels are associated with increased rates of potentially preventable hospitalizations (PPHs) in persons with diabetes.MethodA total of 565 adults aged 65+ ever treated for diabetes were enrolled from Adult Changes in Thought study. PPHs were from principal discharge diagnoses and included diabetes PPH (dPPH), respiratory PPH (rPPH), urinovolemic PPH (uPPH), cardiovascular PPH, and other PPH. Poisson generalized estimating equations estimated rate ratios (RRs) and 95% confidence intervals (CIs) for the associations between dementia or HbA1c measures and rate of PPHs.ResultsA total of 562 individuals contributed 3 602 dementia-free years, and 132 individuals contributed 511 dementia follow-up years. One hundred twenty-eight (23%) dementia-free individuals had 210 PPH admissions and a crude rate of 58 per 1 000 person-years, while 55 (42%) individuals with dementia had 93 PPH admissions and a crude rate of...

Research paper thumbnail of Early Detection of Mild Cognitive Impairment (MCI) in Primary Care

The Journal of Prevention of Alzheimer's Disease, 2020

Mild cognitive impairment (MCI) is significantly misdiagnosed in the primary care setting due to ... more Mild cognitive impairment (MCI) is significantly misdiagnosed in the primary care setting due to multi-dimensional frictions and barriers associated with evaluating individuals’ cognitive performance. To move toward large-scale cognitive screening, a global panel of clinicians and cognitive neuroscientists convened to elaborate on current challenges that hamper widespread cognitive performance assessment. This report summarizes a conceptual framework and provides guidance to clinical researchers and test developers and suppliers to inform ongoing refinement of cognitive evaluation. This perspective builds upon a previous article in this series, which outlined the rationale for and potentially against efforts to promote widespread detection of MCI. This working group acknowledges that cognitive screening by default is not recommended and proposes large-scale evaluation of individuals with a concern or interest in their cognitive performance. Such a strategy can increase the likelihoo...

Research paper thumbnail of Reply to: MoCA Test Mandatory Training and Certification: What Is the Purpose?

Journal of the American Geriatrics Society, 2019

Research paper thumbnail of Behavioral Markers of Resilience in Care Partners of Persons with Dementia: A Thematic Analysis from a Scoping Review

Innovation in Aging, 2019

Caring for a person with dementia (PWD) requires commitment, flexibility, and resilience - the ab... more Caring for a person with dementia (PWD) requires commitment, flexibility, and resilience - the ability to endure and recover from stressors that arise during the caring process. However, it is unknown what behaviors can indicate resilience in care partners (CPs) of PWDs. We examined 46 peer-reviewed articles (1990 to 2018) that included measures or definitions of resilience in CPs of PWDs. Our goal is to identify resilience-related behaviors and create a behavior-based model/framework for CPs of PWDs. Three major themes emerged: (1) Problem-response behaviors (problem-identifying, problem-solving, problem-distancing, learning, and reflection); (2) self-growth behaviors (self-care, creative/spiritual activities, and developing/maintaining meaningful social relationships); (3) help-related behaviors (help-seeking and help-receiving). These findings informed the development of a behavior-based Care Partner Resilience (CPR) measure. Future steps in this research include evaluating to wh...

Research paper thumbnail of Reducing Barriers to Mental Health Care: Bringing Evidence‐Based Psychotherapy Home

Journal of the American Geriatrics Society, 2019

OBJECTIVESBarriers to treatment for depression and anxiety are prevalent among older adults and c... more OBJECTIVESBarriers to treatment for depression and anxiety are prevalent among older adults and caregivers living in the community. We designed and implemented an evidence‐based psychotherapy program to reduce obstacles to care.DESIGNA practice improvement initiative providing no‐fee evidence‐based mental health care at home in clients' primary languages.SETTINGIndependence at Home, a community service of SCAN Health Plan in Southern California.PARTICIPANTSDiverse older adults and adult caregivers of older people with age‐related disability (mainly dementia).INTERVENTIONRedesign of an existing supportive counseling program to improve access to validated models of psychotherapy for depression and anxiety.MEASUREMENTSWe describe program content, phases of development, equity in participation from referral to program completion, clinical outcomes, and estimated direct program delivery costs.RESULTSInsights successfully served demographically diverse clients experiencing a broad ran...

Research paper thumbnail of Potentially Un-Avoidable Hospitalizations in Dementia: An Inside Story

Innovation in Aging, 2018

Research paper thumbnail of Operationalizing the Concept of Resilience for Dementia Caregiving

Innovation in Aging, 2018