MERGING AN AGE FRIENDLY UNIVERSITY WITH AN AGE FRIENDLY HEALTH CARE SYSTEM: CASE STUDY FINDINGS

Age Friendly Health Systems (AFHSs) and Age Friendly Universities (AFUs) are distinct entities in the "Age Friendly” ecosystem. While Age Friendly entities function independently, they typically exist in close proximity (e.g., universities and community hospitals);yet they remain isolated in their Age Friendly efforts. We report on a collaboration between a mid-Atlantic Age Friendly University and a new AFHS using case study methodology. Our goal is to inform and inspire key stakeholders responsible for creating innovative healthy aging communities. The collaboration began with a shared stakeholder team who articulated focus areas and overlapping goals. A charter document was developed articulating commitments and responsibilities. Using a Quality Improvement (QI) approach, projects targeted the hospital's older patient needs that linked to the AFHS 4 M's of Matters, Medications, Mobility, and Mentation. University graduate students and faculty volunteered to teach and mentor hospital staff on the QI projects: 1) Get to Know Me Boards filled by staff caring for hospitalized older adults (Matters);2) Medical Intensive Care Unit discharge opioid medication deprescribing (Medication);3) UMove Mobility Screening addressing functional status (Mobility);4) UB-2 Delirium Screening (Mentation). Data collection across projects demonstrated proof-of-concept and identified implementation challenges around communication, screening, data entry, and data extraction from electronic medical records. During Covid-19 pandemic, the collaboration allowed QI projects to conduct multiple Plan-Do-Check-Act cycles while contributing to the Age Friendly goals of both organizations. Partnerships between academic institutions and hospitals foster development of evidence- based healthy aging communities and provide opportunities for continuing education and research.

FUNCTION FOCUSED CARE FOR ACUTE CARE: OVERCOMING RECRUITMENT, MEASUREMENT, AND IMPLEMENTATION POST-COVID-19

To help patients spend more time engaged in physical activities and avoid the complications that occur Function Focused Care for Acute Care was developed (FFC-AC-EIT). FFC-AC-EIT includes the implementation of four steps: (1) Environment and policy assessments;(2) Education of staff;(3) Establishing patient goals;and (4) Mentoring and motivating of staff, patients, and families. A total of 600 patients from 12 hospitals will be included. Eligibility of patients is based on being 55 years of age and older, admitted for a medical reasons excluding COVID-19, and demonstrating evidence of dementia. Outcome measures are obtained at baseline, discharge, 1, 6 and 12 months post discharge and include physical function, physical activity, pain and pain management, psychological and behavioral symptoms associated with dementia, delirium and adverse events (falls, rehospitalizations, nursing home admissions). Due to COVID-19 innovative approaches were implemented to be able to initiate and continue with the study. These included: identifying potential participants that were COVID-19 free off site;transitioning some intervention activities with staff to online;completing verbal consent with proxies versus face to face;adjusting follow up MotionWatch 8 deliveries and placements to be done without face to face interaction;and adjusting recruitment time periods and intervention activities to fit with intermittently high periods of COVID-19. This symposium will describe intervention challenges, solutions and lessons learned, describe an effective process and measurement model for identification of participants with dementia;and provide optimal ways to measure pain and physical activity among older adults with dementia.

INTERVENTION FIDELITY IN THE FAMILY-CENTERED FUNCTION-FOCUSED CARE INTERVENTION

This session will provide a description of the treatment fidelity (TF) plan from the Family-centered Function-focused Care (Fam-FFC) trial. Components of the TF plan, measures, procedures for implementation, and findings will be presented, and discussed within the context of the COVID-19 pandemic. The components of the Fam-FFC TF plan and results include: 1) Delivery based on completion of the steps in Fam-FFC ;2) Receipt based on evidence of Staff knowledge of Fam-FFC (percentage of nursing staff that demonstrated test scores above 80%);3) Enactment based on achievement of goals using the Goal Attainment Scale ;completion of the Fam-Path Audit of bedside goals and treatment plans, post-acute follow-up and plan update ;and evidence of Fam-FFC based on the Fam-FFC Behavior Checklist (80% staff performance of Fam-FFC). The TF plan demonstrated evidence of delivery, receipt and enactment of study activities. Findings will be used to develop an implementation trial.

Factors That Influence Physical Activity in Hospitalized Patients with Dementia

Introduction: Despite current recommendations, hospitalized older adults, particularly those with dementia, continue to spend little time engaged in physical activity when hospitalized. The purpose of this study was to 1) describe activity among hospitalized older adults with dementia and 2) test the association between specific factors (age, gender, race, cognitive status, comorbidities, baseline function, quality of care interactions, admission diagnosis, and hospital setting) and their physical activity. Methods: This was a descriptive study utilizing baseline data on the first 155 participants of a randomized clinical trial testing the impact of Function Focused Care for Acute Care using the Evidence Integration Triangle (FFC-AC-EIT). This study's major outcome variable of physical activity was based on accelerometry data (MotionWatch8) over the first 24 hours of admission. Three regression models were tested using linear regression and the stepwise approach. Results: The 155 participants had a mean age of 83.5 years old, were 67.7% female, and 65.2% white. The participants spent an average of 1.3% of time in vigorous activity, 3.9% of time in moderate activity, 14.7% of time in low activity, and 80.1% of time in sedentary activity during the first 24 hours of hospitalization. Less cognitive impairment was associated with greater moderate activity (b=-93.408, p=.007) and better baseline mobility was associated with greater low activity (b=-949.453, p=.049). Alternatively, we found that higher age (b=189.350, p=.047), worse baseline mobility (b=2371.364, p=0.004), and non-white race (b=6705.916, p=<0.001) were associated with sedentary behavior. The examined factors for the moderate activity, low activity, and sedentary behavior models only explained 15%, 8%, and 22% of the variance respectively. Conclusions: The findings from this study support the limited time spent in activity for older adults with dementia when hospitalized. This research highlights patient profiles that are particularly vulnerable to sedentary behavior in the hospital and should be identified for activity interventions. Future research should consider other factors such as providers' racial bias, COVID-19 related health professional staffing shortages and burn out, and patient motivation.