ALZHEIMER'S DISEASE RISK REDUCTION HEALTH COACHING: ALCOHOL EFFECTS

Lifestyle risk reduction at the community-level, is currently considered an effective method to decrease Alzheimer's disease (AD). As part of the Virginia Commonwealth University iCubed Health and Wellness in Aging Core, diverse older adults (60+) in Richmond, VA, with incomes below $12,000/year and managing either diabetes/cardiovascular symptoms, were offered weekly lifestyle telephone-health coaching for 12-weeks, providing education, support, and monitoring for AD lifestyle risk in 2020-21. The study sample (n=40, mean age 68 years (range: 60-77 years) was 88% African American/Black (n=35), 100% Non-Hispanic, 45% males (n=18)), 60% reporting memory problems and 53% reporting any alcohol consumption. Thirty-nine (95%) of subjects successfully participated in coaching sessions;on average 91.9% (11) sessions were completed. Participants provided positive anecdotal feedback and the need for continued coaching during COVID. Average drinks per day decreased across the study period (F=7.44;p=.01) and alcohol risk, defined as more than 1 drink/day, decreased (F=3.46;p=.07). Drinking at baseline was associated with differential change in nicotine dependence (F=14.00 ;p=.02), depression risk (F=3.20;p=.09), light physical activity (F=4.52;p=.05), and cognition (COGTEL) (F=6.35;p=.02). Drinking between-subject effects indicated poorer level differences for smoking risk (F=5.68;p=.02), physical inactivity risk (F=4.66;p=.04), and total health behavior risk (F=14.54;p=.001), but higher cognition-scores (F=3.18;p=.11) for drinkers. In conclusion, there may be a paradoxical health effect for alcohol, with associations for negative health behaviors, but positive cognitive functioning. In conclusion, this preliminary work creates the impetus for future large-scale AD risk reduction investigations to improve the lives of AD-risk, low-income, diverse older adults reporting alcohol consumption.

Alzheimer's Disease Prevention Health Coaching.

BACKGROUND: Widespread lifestyle risk reduction at the community level is considered effective in decreasing Alzheimer's disease (AD). To address the limited use of risk deduction in AD, this study aimed to explore the feasibility of community-level implementation. Diverse older adults (60+) living in Richmond, VA, with incomes below $12,000/year and managing diabetic/cardiovascular symptoms were offered weekly lifestyle telephone-health coaching for 12-weeks in 2019-2020 (Phase 1). The health coaching sessions were framed to provide AD lifestyle risk reduction education, goal setting, and support: motivations and self-efficacy. The study sample (n=40, mean age 68 years (range: 60-76 years)) was 90% African American/Black (n=36), 100% Non-Hispanic, and 45% males (n=18). Twenty-five participants (60%) reported experiencing some/often memory problems in the last 12-months. Thirty-nine (95%) of subjects successfully participated in coaching sessions; on average, 11 (91.9%) sessions per subject were completed. Participants provided positive anecdotal feedback and stated the need for continued health coaching. Consequently, n=30 (75%) of the original sample consented to continued health coaching during the 2020-2021 COVID-19 pandemic (Phase 2). All study subjects were examined at baseline (Time 1), 3-month (Time 2), covid-baseline (Time 3), and 3-months postcovid-baseline (Time 4). Repeated Measures ANOVAs were done to examine Time and Time*Memory Status effects. RESULTS: There was a total risk reduction at Phase 1 (F=9.26; p=.004; effect size=.19). At Phase 2, alcohol use decreased (p=.05), quadratic time effects were observed in physical activity (p=.01-.02), and cubic time effects were observed in depression (p=.02). Overall, total risk reduction in Phase 2 was observed at F=5.05; p=.03 effect size=.16. Pre/post-test analyses indicated improvement in Memory Problem Time Interaction (p=.007), AD knowledge (p=.01-.03), and Tired Days (p=.04) across Phase 1. There was also improvement in Social Isolation Time Interaction (p=.03); Tobacco Addiction (p=.001); Poor Mental Health Days (p=.05), and Worried Days Time Interaction (p=.02-.01) across Phase 2. Between subject Memory Status effects, indicating poorer baseline levels for individuals reporting memory problems had greater improvement seen in memory complaints (p=.001), poor mental health days (.02), and tired days (.003-.01). CONCLUSIONS: This preliminary work creates the impetus for future large-scale lifestyle AD risk reduction investigations to mitigate and improve modifiable AD risk among low-income, diverse older adults, including individuals reporting memory problems. Our findings surrounding participant engagement and positive trends in AD risk reduction support the hypothesis that telephone-based health coaching is a practical and feasible AD risk reduction intervention.

The lived experience of low-income older adults during the COVID-19 pandemic

Background: Older adults have been disproportionately affected by COVID-19. The primary goal of this study is to increase understanding of how the COVID-19 pandemic impacts independent-living low-income older adults in an urban setting and how they are managing the everyday challenges resulting from the COVID-19 crisis. Methods: In a mixed-methods study of participants in Virginia Commonwealth University's Richmond Health and Wellness Program, telephone surveys were conducted with 100 older adults using the Epidemic - Pandemic Impacts Inventory Geriatric Adaption. Survey responses were statistically analyzed for income and education effects across seven aggregated domains: home life problems, social activities, isolation problems, economic problems, emotional health-wellbeing problems, physical health problems, COVID infection history, and positive change behaviors/experiences. Qualitative analysis identified emergent themes from fifteen individuals who were further interviewed. Results: Ages of study participants ranged from 55-87, 88% were Black, 57% reported incomes of less than $10,000, and 60% reported high school education or below. Income and education effects were only seen for the social activities and isolation problems (t = -1.82, p < .04) and positive change behaviors/experience domains (t = -2.23, p < .03). The themes that surfaced within the qualitative interview align with the quantitative results in the survey. The three most prevalent themes include 1) societal environment, including culture and trust of the health care and political systems, 2) personal environment, including housing, economics, literacy, mobility, and technology and 3) emotional impact, including trauma, anxiety and depression among other domains. Conclusions: Findings suggest that lower income and education may be risk factors for positive coping behaviors during a crisis event. The identification of how individuals feel and are able to cope was found to be related to perceived locus of control. Further research on improving coping strategies as a potential pathway for intervention is warranted.