Testing the 'Faith Moves Mountains model' to increase Alzheimer's disease awareness, detection, and diagnosis among rural, racially, and ethnically diverse older adults.

OBJECTIVES: Racially and ethnically diverse populations have recently contributed to the majority of rural and small-town growth. Consequently, the disproportionately high risk and prevalence of Alzheimer's disease and related dementias (ADRD) among rural and minoritized older residents will likely increase. To address this threat, we tested the hypotheses that (1) a faith-based, resident-led approach would increase basic ADRD knowledge and diagnosis, and (2) older age, female gender, lower educational levels, and more years lived rural would predict number of referrals, new dementia diagnoses, and treatment. METHODS: An adaptation of Schoenberg's Faith Moves Mountains model, previously successful in detection and management of other chronic illnesses in rural settings, guided this community-based participatory research. Local faith community members were trained as research assistants to recruit, administer surveys, conduct brief memory assessments, teach brain health strategies, and follow-up with residents. Outreaches were offered virtually during the pandemic, then in-person monthly at rotating church sites, and repeated ∼1 year later. RESULTS: This rural sample was racially and ethnically diverse (74.5% non-White), with 28% reporting eight or less years of formal education. Findings included that referrals and years lived rural were significant and positive predictors of new ADRD treatments [(b = 3.74, χ2(1, n = 235) = 13.01, p < 0.001); (b = 0.02, χ2(1, n = 235 = 3.93, p = 0.048)], respectively, regardless of participant characteristics. CONCLUSION: Resident-led action research in rural, diverse, faith communities is a successful approach to increasing ADRD disease knowledge, detection, diagnosis, and treatment.

Improving Behavioral and Psychological Symptoms and Cognitive Status of Participants with Dementia Through the Use of Therapeutic Interactive Pets.

In the US, one in three older adults die with Alzheimer's disease or a related dementia. Currently, there is no cure for the rapidly growing burden, but there are pharmacological treatments to manage the symptoms, which lead to numerous side effects. We tested the effectiveness of a non-pharmacological therapeutic interactive pet (TIP) in improving mood/behavior and cognition among 12 persons with mild-moderate dementia attending an adult day center (ADC) over 12 visits. Mood/behavioral symptoms were assessed using the Alzheimer's Disease and Related Dementias Mood Scale (AD-RD), Observed Emotion Rating Scale (OERS), and the Cornell Scale for Depression in Dementia (CSDD). Cognition was assessed via Mini Mental State Examination (MMSE). Paired-sample t-tests, Pearson's correlation, repeated measures t-test, and a post-intervention qualitative inquiry were used to examine the significance of TIP. As a result, all mood scores improved over time, with two showing significance: OERS (M = 73.7/SD = 9.6); conditions t(11) = -19.18, p<.001, and CSDD (M = 8.8/SD = 7.2); conditions t(11) = 4.12, p =.002. Over half (0.67%) scored higher on the MMSE post-test than the pretest: M = 10.7(SD = 5.5) and M = 12.2(SD = 7.1), respectively. Participants stroked and spoke often to their pets. Several family members reported participants sleeping with their pet following the program's conclusion. TIP proved to be a safe alternative method to improving mood/behavior in persons with dementia attending an ADC. MMSE scores also improved, although confounding factors such as inter-rater reliability and a potential endorphin effect may have impacted scores. Improving Behavioral and Psychological Symptoms and Cognitive Status of Participants with Dementia through the Use of Therapeutic Interactive Pets.

Discerning rural Appalachian stakeholder attitudes toward memory screening.

OBJECTIVE: The aim of this descriptive study was to examine Appalachian stakeholder attitudes toward routine memory screening, and to compare and contrast results from a similar study conducted in an ethnically diverse rural Florida cohort. Determining perceptions about memory screening is essential prior to developing culturally relevant programs for increasing early dementia detection and management among rural underserved older adults at risk of cognitive impairment. Benefits of early detection include ruling out other causes of illness and treating accordingly, delaying onset of dementia symptoms through behavior management and medications, and improving long-term care planning (Dubois, Padovani, Scheltens, Rossi, & Dell'Agnello, 2016). These interventions can potentially help to maintain independence, decrease dementia care costs, and reduce family burdens (Frisoni, et al., 2017). METHOD: Researchers applied a parallel mixed method design (Tashakkori & Newman, 2010) of semi-structured interviews, measurements of health literacy (REALM-SF) (Arozullah, et al., 2007), sociodemographics, and cognitive screening perceptions (PRISM-PC) (Boustani, et al., 2008), to examine beliefs and attitudes about memory screening among 22 FL and 21 WV rural stakeholders (residents, health providers, and administrators). RESULTS: Findings included that > 90% participants across both cohorts were highly supportive of earlier dementia detection through routine screening regardless of sample characteristics. However, half of those interviewed were doubtful that provider care or assistance would be adequate for this terminal illness. Despite previous concerns of stigma associated with an Alzheimer's disease diagnosis, rural providers are encouraged to educate patients and community members regarding Alzheimer's disease and offer routine cognitive screening and follow-through.

Enhancing Dementia Education and Cognitive Screening in A Haitian Population: A Faith-based Approach.

Ethnically diverse Americans experience 1.8-2.5 times higher risk of developing Alzheimer's disease than Whites (Mayeda, et al., 2016), yet cognitive screening is not routinely conducted among Haitian American communities. Dementia risk awareness is beneficial for improving management of chronic illness and behaviors that impact risk of cognitive decline. A quasiexperimental paired samples t-test design was employed to test the effectiveness of an educational intervention among 50 older faith- based Haitian adults using the Basic Knowledge of Alzheimer's Disease (BKAD) scale, cognitive screening using the Cognitive State Test (COST), and referrals to a local memory/wellness center. A significant difference was seen in knowledge scores: pre-test (M = 18.5, SD = 3.12) and post-test (M = 23.1, SD = 2.42); conditions t(41.9) = -9.5, p = .000. All of those who volunteered for screening completed follow-up neuropsychological evaluations. Outreach to faith-based settings is suggested as an avenue for improving dementia knowledge and detection.

Detecting dementia among older, ethnically diverse residents of rural subsidized housing.

Rural, ethnically diverse residents face at least twice the risk of Alzheimer's disease than urban residents. Chronic diseases such as diabetes and hypertension which increase dementia risk are more prevalent in rural areas with less access to specialty providers. A home-based approach for increasing dementia detection and treatment rates was tested among rural residents of government-assisted independent living facilities (N = 139; 78% non-White, and 70% with health literacy below 5th grade). Of 28 residents identified at risk during cognitive screening, 25 agreed to further in-depth assessment by adult gerontological nurse practitioners (AGNP). Fifteen of 25 (60%) completing consequent primary provider referrals were diagnosed with dementia and receiving new care (statistically significant; [χ2(1) = 76.67, p < .001, Phi = 0.743]). Home-based dementia management through a community engagement approach can help to meet the Healthy People 2030 goals of earlier detection and treatment and reduce the length of costly institutionalizations.

An updated measure for investigating basic knowledge of Alzheimer's disease in underserved rural settings.

Objective: Older rural adults face a higher burden of Alzheimer's disease (AD) and delayed detection. This risk is heightened in rural populations that are ethnically diverse. Patients and providers are often hesitant to participate in screening, partially due to gaps in knowledge of the current science. The purpose of this paper is to describe the results of administering the revised version of the Basic Knowledge of Alzheimer's Disease (BKAD) measure in small rural communities in five different states.Methods: The BKAD measure was revised after first being tested in rural Appalachia. Revisions including eliminating non-discriminating items and adding questions regarding early detection, sleep, head injury, and vision changes. Reliability and validity testing included Cronbach's alpha and Rasch item analysis, test-retest, and predictive validity. Descriptive measures and independent sample t-tests were used to analyze knowledge gaps and sociodemographics.Results: Tests for reliability and validity were highly favorable, including Cronbach's alpha = .85 and overall Rasch item analysis of .94. Three-fourths of participants knew that annual cognitive screening was recommended for older adults, but only one-fourth had been previously screened. Sociodemographic findings revealed that a majority of participants (86%) would participate in annual memory screening if offered, regardless of education or health literacy level.Conclusion: The BKAD measure is a good fit for use in rural and underserved populations. BKAD results can inform the design of culturally relevant programs for raising awareness of the importance of early AD detection and treatment.

Supporting Safety in the Older Adult Driver: A Public Health Nursing Opportunity.

The effective operation of a motor vehicle encompasses a wide range of cognitive processes that can decline due to age-related changes in neuroanatomical structures and cognitive functionality. The increasing number of older adult drivers in our rapidly aging population heightens the public safety concern of unsafe driving associated with these changes. Nurses caring for older adults in public health settings are well positioned to make a difference in the management of older patients who may be at risk of endangering themselves or others on the roadways. In this article, information is provided for increasing nurses' awareness of the cognitive factors inhibiting effective driving, recognizing older adults who may be at risk for unsafe driving, and facilitating a patient/family to seek a driving evaluation.

Annual Cognitive Assessment for Older Adults: Update for Nurses.

Alzheimer's disease is predicted to bankrupt Medicare by 2050 if current trends in disease prevalence do not change (Alzheimer's Association, 2012). Earlier diagnosis and access to health care for Alzheimer's disease result in decreased health care costs (Brosch & Matthews, 2014). Consequently, in January 2011 screening for cognitive impairment became a component of the annual wellness visit (AWV) outlined in the Patient Protection and Affordable Care Act. Many community health nurses are unaware of this benefit. This article includes a review of the updated 2011 definition of Alzheimer's disease, the components of the AWV, and tools for conducting cognitive assessment.

Community-Based Strategies to Reduce Alzheimer's Disease and Related Dementia Incidence Among Rural, Racially/Ethnically Diverse Older Adults.

Purpose of Review: The purpose of this paper was to address the research question "What recent advances in Alzheimer's Disease and Related Dementias (ADRD) risk reduction strategies can be tailored for rural, racially/ethnically diverse populations?" A rural resident's life story that grounded the work is shared. Next, a brief description is provided regarding ADRD risk factors of importance in rural, multicultural settings. Gaps in U.S.-based research are highlighted. Policy actions and interventions that may make a difference in alleviating rural, ADRD-related disparities are offered. Recent Findings: More than a dozen factors, including lack of built environment, periodontitis, poor air quality, and sensory loss, were identified that are of particular relevance to rural groups. Evidence of importance to underserved residents has also emerged regarding the harmful effects of ultra-processed foods on brain health, benefits of even minimal physical activity, and importance of social engagement, on brain health. Summary: Resident-led initiatives will be key to creating change at the community level. Health providers are also called to assist in identifying and adapting culturally specific upstream approaches, in partnership with community stakeholders. These mechanisms are vital for decreasing ADRD burdens in underserved communities facing the largest disparities in preventive care.

Responding to a simulated disaster in the virtual or live classroom: Is there a difference in BSN student learning?

AIM: This study aim was to investigate if prelicensure baccalaureate nursing students gained more knowledge from a live or virtual disaster simulation. The study goal was to inform the use of e-learning or traditional textbooks in undergraduate nursing population health courses. BACKGROUND: Weather-related disasters have increased in frequency and severity in the past ten years, with 2020 being the most active storm season ever seen (National Oceanographic and Atmospheric Administration, 2021.) Even with advances in early warning systems and mitigation efforts, educating student nurses in disaster response remains a priority. Due to the impact of Covid-19 quarantine policies, many in-person student learning labs and clinical experiences were cancelled. However, virtual simulation offers an alternative to developing nursing student skills and clinical reasoning ability (Aebersold, 2018; Fogg et al., 2020). DESIGN: A randomized quasi-experimental, repeated measures 2 × 2 crossover design (Kim, 2018) was applied, which allowed students to participate in both the live and virtual simulations. METHODS: Analysis was conducted using paired samples t-test to evaluate knowledge gains. To measure students' self-assessment of knowledge, Unver et al. (2018) 12-item survey was administered. To explore students' own perceptions about the disaster simulations, semi-structured interview questions were offered through private Wiki postings. The responses were analyzed using Saldaña's in vivo coding (2015) and thematic analysis. RESULTS: Students retained more empirical knowledge following the virtual assignment as compared to the disaster simulation, except in two items addressing triage. Neither age, years of education, or GPA impacted test results. However, students' own assessment of learning did not differ between live and virtual simulations. In all but three items, students perceived a significant increase (p < .05) in their learning following the simulation, regardless whether it was live or virtual. In narrative responses, students overwhelmingly cited the benefit of an in-person simulation. However, they did not believe that they were prepared adequately for the live simulation. They also expressed that they would be more prepared if the simulation was repeated. Students expressed discomfort, even distress, regarding not being able to care adequately for everyone, even though it was a simulation (See Table 5). This highlighted that live simulations can affect students emotionally, and follow-up debriefing is essential to help in both acknowledging and processing student feelings. CONCLUSION: These findings, which support the use of virtual disaster training in nursing education, are especially important in the light of Covid-19 and increasing threat of storm disasters.

Overcoming the COVID-19 Pandemic for Dementia Research: Engaging Rural, Older, Racially and Ethnically Diverse Church Attendees in Remote Recruitment, Intervention and Assessment.

BACKGROUND: Access to cognitive screening in rural underserved communities is limited and was further diminished during the COVID-19 pandemic. We examined whether a telephone-based cognitive screening intervention would be effective in increasing ADRD knowledge, detecting the need for further cognitive evaluation, and making and tracking the results of referrals. METHOD: Using a dependent t-test design, older, largely African American and Afro-Caribbean participants completed a brief educational intervention, pre/post AD knowledge measure, and cognitive screening. RESULTS: Sixty of 85 eligible individuals consented. Seventy-percent of the sample self-reported as African American, Haitian Creole, or Hispanic, and 75% were female, with an average age of 70. AD knowledge pre-post scores improved significantly (t (49) = -3.4, p < .001). Of the 11 referred after positive cognitive screening, 72% completed follow-up with their provider. Five were newly diagnosed with dementia. Three reported no change in diagnosis or treatment. Ninety-percent consented to enrolling in a registry for future research. CONCLUSION: Remote engagement is feasible for recruiting, educating, and conducting cognitive screening with rural older adults during a pandemic.

Assessment of Basic Knowledge About Alzheimer's Disease Among Older Rural Residents: A Pilot Test of a New Measure.

BACKGROUND AND PURPOSE: Underserved rural populations face a higher risk of Alzheimer's disease (AD), yet studies investigating AD knowledge in this population are lacking. The purpose of this research was to develop an AD basic knowledge measure that is appropriate for use with underserved populations. METHOD: A content domain map, content validity index, and cognitive interviews were used in developing the first version of the basic knowledge of Alzheimer's disease (BKAD; Study 1). Reliability and validity of the measure in this descriptive study were examined using Rasch modeling and tests for construct, concurrent, and discriminate validity (Study 2). Multiple regression was employed to examine AD knowledge predictors. RESULTS: Findings included that the BKAD instrument discriminated well between persons with varied education levels. Psychometric analysis yielded important information to guide revision of the BKAD measure. CONCLUSION: The BKAD measure shows promise in meeting the need for a culturally relevant measure to assess basic Alzheimer's disease knowledge in underserved rural populations.