Older Veterans Research Articles

VO2MAX, 6-minute walk, and muscle strength each correlate with frailty in US veterans.

Frailty often manifests as an increased vulnerability to adverse outcomes, and detecting frailty is useful for informed healthcare decisions. Veterans are at higher risk for developing frailty and at younger ages. The goal of this study was to investigate approaches in Veterans that can better inform the physiologic underpinnings of frailty, including maximal oxygen uptake (VO2max), 6-min walk, muscle strength, and inflammatory biomarkers. Participants (N = 42) were recruited from the Buffalo VA Medical Center. Inclusion criteria: ages 60-85, male or female, any race, and not having significant comorbidities or cognitive impairment. Outcome measures included: the Fried frailty phenotype, the short physical performance battery (SPPB), quality of life (QOL) using the Q-LES-Q-SF, and the following physiologic assessments: VO2max assessment on an upright stationary bicycle, 6-min walk, and arm and leg strength. Additionally, inflammatory biomarkers (C-reactive protein, IL-6, IL-10, interferon-γ, and TNF-α) were measured using ELLA single and multiplex ELISA. Participants: 70.3 ± 7.4years of age: 34 males and 8 females, BMI = 30.7 ± 5.4kg/m2, 26 white and 16 African American. A total of 18 (42.8%) were non-frail, 20 (47.6%) were pre-frail, and 4 (9.5%) were frail. VO2max negatively correlated with Fried frailty scores (r = -0.40, p = 0.03, N = 30), and positively correlated with SPPB scores (r = 0.50, p = 0.005), and QOL (r = 0.40, p = 0.03). The 6-min walk test also significantly correlated with VO2max (r = 0.57, p = 0.001, N = 42) and SPPB (r = 0.55, p = 0.0006), but did not quite reach a significant association with frailty (r = -0.28, p = 0.07). Arm strength negatively correlated with frailty (r = -0.47, p = 0.02, N = 26), but not other parameters. Inflammatory profiles did not differ between non-frail and pre-frail/frail participants. Objectively measured cardiorespiratory fitness was associated with important functional outcomes including physical performance, QOL, and frailty in this group of older Veterans. Furthermore, the 6-min walk test correlated with VO2max and SPPB, but more validation is necessary to confirm sensitivity for frailty. Arm strength may also be an important indicator of frailty, however the relationship to other indicators of physical performance is unclear.

ENHANCING CARE FOR OLDER VETERANS WITH COMPLEX PHYSICAL, COGNITIVE, AND PSYCHOLOGICAL COMORBIDITIES

Abstract Older veterans present in healthcare settings with more diagnoses than younger veterans and non-veteran older adults. Older veterans are also more likely to present with co-occurring physical, cognitive, and psychological conditions that are difficult to assess and treat. This is further complicated by the fact that many older veterans reside in rural areas without easy access to specialty care and, even in non-rural settings, there is a dire shortage of providers with geriatric expertise both within and outside of the Veterans Health Administration (VHA) system. The current symposium highlights promising findings from a variety of VHA programs aimed at enhancing the quality and reach of care provided to older veterans with complex needs. First, Dr. Bamonti will present mixed-methods results from her work in the development of Step-Cognitive Behavioral Therapy, a novel virtual intervention for older veterans with COPD. Second, Ms. Carlson will describe program evaluation outcomes from a project aimed at expanding geriatric mental health services via telehealth to older veterans with complex needs residing in rural areas. Third, Dr. Peeples will discuss factors affecting the implementation of the VA Behavioral Recovery Outreach Team model, which is aimed at facilitating successful discharge from inpatient settings and preventing rehospitalization for older veterans. Finally, Dr. Gregg will describe qualitative findings examining a component of the Geriatric Scholars Program for Psychologists, a national post-licensure training program for psychologists treating older rural veterans with complex needs. Dr. Karel, National Director of VHA Geriatric Mental Health, will close with discussion and highlight future directions.

EXAMINING THE GERIATRIC SCHOLARS PROGRAM: IMPACT ON CLINICAL PRACTICE AMONG VA PSYCHOLOGISTS

Abstract Since 2014, the Geriatric Scholars Program – Psychology Track (GSP-P) has offered VA post-licensure psychologists with little-to-no prior geropsychology training an opportunity to enhance their knowledge and skills to better serve rural-dwelling older Veterans. This is achieved through an intensive course on geropsychology competencies, completion of a geriatric mental health focused quality improvement project and optional advanced learning components. A survey of GSP-P alumni was conducted to assess the long-term impact of participation on clinical practice with older Veterans and overall job satisfaction. Out of 148 alumni, 40 (27%) responded to the survey. Most alumni reported working within the home based primary care setting (45%), with the others working in a range of inpatient and outpatient settings. Utilizing a retrospective post-pre design, practice change was evaluated using a measure comprised of 12 items related to clinical practices/behaviors with older Veterans (e.g., “Incorporated a caregiver/family member in the assessment of an older Veteran.”) both before and after participating in the GSP-P. A paired samples t-test, t(29) = -2.91, p = .007, demonstrated a significant difference in clinical practice pre to post engagement with GSP-P, with participants reporting more frequent age-adapted clinical practices/behaviors post GSP-P participation. Sensitivity analyses showed a moderate effect size d = -.53 (95% CI: -.91, -.144). Qualitative responses reflected alumni growth in confidence and satisfaction in working with older Veterans, as well as more utilization of age-adapted evidenced based assessment and intervention. Overall, this evaluation shows that targeted training can improve psychologists’ clinical practice with older Veterans.

VIRTUAL TAI CHI FOR OLDER VETERANS IMPACTED BY COVID-19

Abstract As older Veterans (OV) were at risk for loneliness and deconditioning during the COVID pandemic, they were invited to join a Tai Chi program due to its known benefits in these areas. The objectives of this presentation are to examine outcomes, program adherence and feedback of OV enrolled in a 12-week Tai Chi course conducted virtually twice weekly at three VA sites during the COVID-19 pandemic. Participants completed the 30-Second Chair Stand (30CST) and the De Jong Gierveld Loneliness Scale (DJGS) at baseline and again when they finished the course. Attendance was recorded and end-course evaluations were also obtained. Univariate and multivariate statistics were used to summarize results. One hundred eleven OV aged 60 to 94 enrolled. Most were non-Hispanic (84%), white (72%), males (80%), living independently (92%) with a partner (43%). Of these, 86 (77.5%) completed a final assessment after attending a mean of 18.7 out of 24 sessions. Retention did not differ by site nor other demographics. Among the completers, there was not a significant change in DJGS (n=46, p=0.2748), but only 26.1% showed substantive loneliness at baseline. The 30CST improved significantly (n=72, p=0.0150) after controlling for site and baseline value. Most participants described the virtual course as rewarding, beneficial to their health and balance, and conducive to social connection. They also expressed desire to continue the program. Our results suggest OV achieve objective and subjective benefits from, and can feasibly participate in, a virtual Tai Chi program, which appears to be a valid alternative to in-person courses.

AGING IN THE RIGHT PLACE: TEMPORARY SUPPORTIVE HOUSING FOR OLDER MALE VETERANS IN CALGARY, CANADA

Abstract In 2019 an estimated 1.6% of emergency shelter users in Canada were veterans (1,905 individuals), which is consistent with the proportion of veterans in the general population (1.7%). However, veterans tend to be older, male, and cite an illness or medical condition as a contributing factor to their homelessness, than their non-veteran counterparts. As part of the Aging in the Right Place (AIRP) study, we sought to understand the housing and support needs of older male military veterans (age 50+) living in a congregate temporary supportive housing in Calgary, Alberta. This exploratory, multi-methods study used: (1) de-identified document review, (2) environmental audit, (3) in-depth qualitative key informant interviews with service providers and (4) in-depth qualitative and Photovoice interviews with older shelter residents to understand the shelter needs of older homeless veterans. The data was collected between February and June 2023. Interviews were transcribed, managed with NVivo 1.6.1, and team-based flexible coding was employed on the key informant (n=5) and shelter resident (n=5) interviews to determine older male veterans’ shelter needs. In this presentation we share the findings of the study and offer recommendations for shelter and services designed to assist older housing insecure veterans to age in the right place.

VIRTUAL COMPREHENSIVE GERIATRIC ASSESSMENT FOR VETERANS: AN INTERDISCIPLINARY QUALITY IMPROVEMENT PILOT PROJECT

Abstract The Veterans Millennium Health Care and Benefits Act requires comprehensive geriatric assessments (CGA) to be provided to all older Veterans as part of the Veterans Medical Benefits Package. Access to a CGA may be difficult for Veterans with limited ability to travel. Currently, in the North Florida/South Georgia (NFSG) Veterans Health System, approximately 11,500 older Veterans are recognized to be at high risk for hospitalization or placement in a long-term care facility, yet only 0.09% of them have received a CGA. NFSG Geriatrics and Extended Care (GEC) developed a standardized virtual CGA process to increase access to geriatric specialty care utilizing VA Video Connect (VVC). The project design and implementation included: the development of a standard operating procedure using evidence-based screening tools, templates, clinic grids and flowcharts, communication channels, and the development of a dashboard for data collection. In addition, the VHA National CGA Template was piloted. This novel Tele-Geriatrics virtual interdisciplinary project allows older Veterans and/or caregivers to remain at their homes for all telehealth/virtual sessions completed by the CGA interdisciplinary team, including pharmacy, nursing, social work, occupational therapy, and geriatric providers. The project demonstrates increased access to comprehensive assessments, consequently closing the gap between current practice and the Veterans Millennium Health Care and Benefits Act requirements. The pilot also decreased the health disparities of rural Veterans. Furthermore, this project helped to increase Veteran knowledge of geriatric syndromes, VA resources, participation in telehealth, and access to durable medical equipment (DME) to help Veterans age in place.

EFFICACY OF MALNUTRITION SCREENING AMONG OLDER VETERANS AT AN URBAN VA HOSPITAL

Abstract Nearly half of the Veteran population is >65 years. Older Veterans are at increased risk of malnutrition associated with increased mortality, morbidity, length of stay, and readmissions. Malnutrition-focused quality measures are needed to combat this public health issue. The purpose of this study was to identify gaps in malnutrition screening at an urban VA facility. Chart auditing was conducted for all medical admissions during 72 hour periods across 14 months. Auditing determined if nutrition screening was completed, with an admission weight, and if nutrition was consulted for nutritionally compromised Veterans. Screening was conducted using the Malnutrition Screening Tool (MST). Additionally, estimated prevalence of nutritionally compromised Veterans was assessed using auditing data from 30 days. Audit data showed that on average only 57.4% (n=458) of Veterans admitted for inpatient care were screened correctly. Of those screened incorrectly, the three most common errors were 1) not collecting a weight on admission (N=82 (42.1%)); 2) inaccurate weight change interpretations (N=41 (21%)); 3) failure to refer nutritionally at-risk Veterans to nutrition services (N=38 19.5%)). Prevalence auditing demonstrated over 1/3 of Veterans were nutritionally compromised at the start of their hospitalization (36.43%, (N=295)). With an increasingly aging population in the United States there is a focus on shifting to value based payment systems. The new CMS Global Composite Malnutrition Score will include evaluation of hospitals malnutrition screening processes. There is a significant opportunity to close these gap areas and to adopt clinically relevant best practices to provide nutrition care earlier to at risk Veterans.

A DISCUSSION ON THE STATE OF AFFAIRS ON DIRECT ACTION TO SUPPORT OLDER ADULTS DURING DISASTERS

Abstract As the frequency and severity of disasters increases, supporting older adults before, during, and after disasters is paramount. Steps toward adequate disaster preparedness include ensuring older adults possess awareness of increased disaster and hazard events and understand their role in preparedness. This symposium will address the current state of affairs in the United States (US) on direct actions to support older adults before, during, and following major disasters. Additionally it will provide context on how continuing effects of climate change impact these efforts. Dr. Lisa Brown will share perspectives and describe efforts of the US National Advisory Committee on Seniors and Disasters. Dr. Sue Anne Bell will discuss the role of implementation science in improving the emergency preparedness in nursing homes. Dr. Lindsay Peterson will describe existing state policies around home and community-based service providers. Dr. Tamar Wyte-Lake will share directions the Department of Veterans Affairs is moving in to best support vulnerable populations, focusing on older Veterans. Dr. Karl Pillemer will address the role of older adults as active agents in climate change prevention and mediation. Dr. David Dosa will act as discussant. These presenters will provide important insights into ongoing efforts while highlighting areas in need of improvement and aligned action, with the hopes that this will generate important discussions well into the future. This is a Disasters and Older Adults Interest Group Sponsored Symposium.

FACILITATING GROWTH VIA INDEPENDENT LEARNING PLANS FOR PSYCHOLOGISTS TREATING OLDER VETERANS WITH CHRONIC ILLNESS

Abstract The VA Geriatric Scholars Program-Psychology Track (GSP) is a national post-licensure geropsychology training program for VA psychologists caring for rural-dwelling older veterans with complex physical, cognitive, and psychological comorbidities. In 2019, GSP developed an advanced workshop model to invest in the continued growth its alumni. The workshop focused on enhancement of geropsychology competencies in treating older veterans with chronic mental and physical illnesses (e.g., PTSD, dementia, diabetes). To facilitate ongoing and individually tailored learning following the workshop, participants developed and executed Independent Learning Plans (ILPs) during a 6-month window with consultation from an experienced geropsychologist. Upon completion, participants submitted final reports and responded to three prompts assessing overall experience, usefulness, and future plans. We examined these qualitative data using a rapid analysis approach with summary templates. Fourteen of 19 participants (73.7%) submitted both final reports and responses to the prompts. All 14 respondents endorsed clinical and/or personal usefulness of the ILPs, with emerging themes including increased confidence, enhanced skills for use with patients with complex needs, and career advancement. Regarding overall experience, most participants noted positive outcomes, including feelings of fulfillment, and noting that ILPs were feasible and learning resources were accessible. A minority (35.7%) identified meaningful barriers most often associated with not having enough time. Future directions included plans to learn new assessment/treatment approaches, read relevant literature, and pursue additional career advancement (e.g., board certification in geropsychology). Overall, our findings suggest ILPs are a viable way to enhance psychologists’ experience and effectiveness in treating older veterans with complex needs.

ASSOCIATION BETWEEN MULTIPLE FRAILTY INDICES AND CVD MORTALITY

Abstract Introduction Frailty, a syndrome of physiologic vulnerability, increases cardiovascular disease (CVD) risk. Which frailty tool is ideal for risk stratification remains unclear. We calculated three frailty scores from the Million Veteran Program (MVP) and examined their association with mortality and CVD in older Veterans. Methods Participants were from MVP - a large, contemporary Veteran cohort study - and aged ≥50 years at baseline (2011-2018). The frailty scores used were: MVP-FI (36-item questionnaire deficit accumulation frailty index), VA-FI (31-item EHR index), and modified Study of Osteoporotic Fractures (mSOF; a physical frailty score). MVP-FI and VA-FI scores of ≤0.10 were robust, 0.11-0.20 pre-frail, and ≥0.21 frail; mSOF scores of 0 were robust, 1 pre-frail and ≥2 frail. Primary outcomes were all-cause and CVD mortality. Secondary outcomes were incident stroke, myocardial infarction (MI), and heart failure (HF). Cox regression was used to evaluate the association of frailty with outcomes. Results Among 190,688 participants, mean age was 69 ±9, 94% were male. By MVP-FI, 29% were robust, 42% pre-frail, and 29% frail. Hazard ratios (HR, 95% CI) for all-cause mortality were 1.66 (1.61-1.72) and 3.05 (2.95-3.16) for pre-frailty and frailty, respectively. For CVD mortality, HRs were 1.76 (1.65-1.88) and 3.65 (3.43-3.90) for pre-frailty and frailty. Hazards of stroke, MI, and HF also increased with greater frailty. VA-FI and mSOF yielded concordant results. Conclusion Irrespective of measure, frailty is associated with increased all-cause mortality and CVD event risk. Clinicians and researchers may consider the most convenient tool for available data to incorporate frailty into practice.

VA’S EXPERIENCE IN BUILDING CAPABILITY TO CONDUCT OUTREACH TO VULNERABLE PATIENTS DURING EMERGENCIES

Abstract The United States (US) has sustained more than 340 weather and climate disasters since 1980. Older adults with complex medical conditions, increasing in numbers, are typically most severely impacted by such events. A growing population of older, medically complex, individuals residing at home, and an increased frequency of severe natural disasters creates a compounded burden on local communities to reduce potential harm to these community-dwelling members during disaster response and recovery. In response, the Veterans Health Administration (VHA) established the Vulnerable Patient Care, Access, and Response in Emergencies (VP CARE) program to provide standardized data tools and guidance to assist VA medical facilities in conducting outreach to and care coordination of medically frail and older Veterans during major emergencies. VP CARE utilizes geographic information system (GIS) tools to allow outreach prioritization based upon geographic proximity to an event and patient clinical needs. In response to Hurricanes Ian and Fiona, the VP CARE team, with the support of the national VEText team, successfully deployed a new 2-way patient texting communication capability. During an emergency, patients receive a text from VEText, are asked whether they require assistance, and the specific help they need. The new VEText capability helped VA staff reduce outreach call volume by 20% and allowed for triage and prioritization of those indicated as needing assistance to the top of the outreach list. This presentation provides an overview of VP CARE approaches and what VHA has learned through its implementation to assist other healthcare systems with establishing similar capabilities.

THE EFFECT OF A DRUG-BURDEN INDEX ON FALLS RISK INCREASING MEDICATIONS DEPRESCRIBING IN VETERANS AT RISK OF FALLING

Abstract Falls risk-increasing medications (FRIMs) have negative effects on balance and psychomotor functioning which increase the risk of falling in older adults. Thus, deprescribing of FRIMs is a recommended fall prevention intervention. The Drug Burden Index (DBI) measures total exposure to anticholinergic and sedative medications and has been associated with falling risk in older adults. We evaluated if inclusion of a DBI score would influence deprescribing of FRIMs in older veterans at risk of falling. A pharmacist conducted a medication review for FRIMs in two cohorts of older veterans participating in a fall prevention group. The primary care prescriber (PCP) was alerted to recommendations through the electronic medical record. Inclusion of the DBI was included and shared with the PCP in the second cohort only. Changes to FRIMs and reduction in DBI score was calculated for all participants three months after initial FRIM review. Nearly all (95%) participants (n=44) were prescribed a FRIM. The most common active prescriptions contributing to DBI score were for anticholinergics (37.9%), antidepressants (33.3%) or anticonvulsants (31.8%) agents. DBI improved in both cohorts, but DBI change was greatest in the second cohort (n=18) (first cohort mean DBI change= 0.168; second cohort mean DBI change= 0.189; p 0.002). Percentage of recommendations accepted and acted upon by PCP was similar between both groups (60% vs 59%). Inclusion of a DBI is a helpful measure of FRIM deprescribing and may further encourage deprescribing behaviors. Feedback from PCPs will clarify the role of DBI in fall prevention medication reviews.

GENDER DIFFERENCES IN COVID-19 EXPERIENCES OF OLDER FEMALE VETERANS USING THE PROSPECTIVE HERO CARE SURVEY DATA

Abstract Aging female Veterans faced unique experiences during the COVID-19 pandemic. We used self-reported experiences of older female Veterans during this time in comparison with male Veterans. We received responses for the HERO CARE survey from 2,080 (88 (4.2%) female, 1,992 (95.8%) male) community-dwelling Veterans from five geographically diverse Veterans Affairs Medical Centers. Veterans were prompted to self-report the impact of COVID-19 through an open-ended question asking to share anything they would like us to know about their experience. Open-ended responses were classified through inductive coding into emergent themes and chi-square tests. The most common emergent themes from female Veteran responses were social isolation (17.8%), negative effects on physical health (15.6%), and issues with accessing VA healthcare resources (15.6%). The most common emergent themes from male Veterans were social isolation (12.7%) and issues with accessing VA healthcare resources (8.2%). However, female Veterans were more likely to report experiencing a decline in their physical health compared to males (p< 0.01), more likely to report experiencing a negative change in their mental health (p< 0.01) and more likely to experience a decline in their general satisfaction with life (p< 0.002). They were also more likely to experience an issue with accessing VA healthcare resources (p< 0.02), and to experience financial problems (p< 0.0001). Female Veterans were more likely to report negative impacts of the COVID-19 pandemic to their mental and physical health, general satisfaction with life, and accessing VA healthcare resources. Routine assessment may be needed to adequately address their needs.

SLEEP DISORDERS AND RISK OF MID- TO LATE-LIFE SUICIDE ATTEMPT

Abstract Sleep is a compelling target for suicide prevention in later life, as 50% of older adults experience sleep difficulties. The primary objective of the current study was to evaluate whether sleep disorders increase risk of late-life suicide attempt and death by suicide. We examined a nationally based cohort of over 5 million US veterans 50 years and older, who used Department of Veterans Affairs (VA) health services. Veterans with a sleep diagnosis (i.e., sleep apnea, insomnia, hypersomnia, and others) at baseline (October 1, 2011, to September 30, 2013) or earlier (October 1, 2007, to September 30, 2011) were propensity matched 1:1 with patients without these diagnoses based on demographic characteristics and Charlson Comorbidity Index (Total N=1,990,362; 995,181 each group). Secondary analyses examined psychiatric disorders as potential moderators. Fully adjusted models (additionally adjusted for psychiatric disorders) demonstrated that patients with sleep disorders had a 23% increased risk of any suicide attempt (HR 1.23, 95% CI [1.20-1.27]), while risk mitigated for lethality of attempt (HR 0.98, 95% CI [0.92-1.03]). Depression, PTSD, and generalized anxiety disorder were all approximately twice as prevalent among the sleep disorder group. Among veterans with a psychiatric disorder, any sleep disorder diagnosis was associated with a 28% increased risk for suicide attempt, which attenuated among those without a psychiatric diagnosis. In conclusion, sleep disorder diagnoses conferred increased risk for suicide attempt, especially in older adults with psychiatric disorders. These findings suggest that treatment of sleep disorders may mitigate risk of suicide attempts in older vulnerable veterans.

RURAL CAREGIVER PERSPECTIVES OF SUPPORTING PATIENT ENGAGEMENT IN VIDEO VISITS

Abstract Rapid integration of telehealth in response to the COVID pandemic highlighted digital divide issues, specifically for video, which is a live, synchronous encounter. Older patients may have difficulty navigating a video session due to age, health-related impairment, or low technical competence. Further, specialty services which involve hands-on care, such as occupational therapy (OT), are more complex to translate to video, potentially necessitating a second person to assist with set-up or delivery of clinical care. Caregivers may aid in bridging the digital divide between patient and clinicians in a video session. However, little is known about caregiver willingness and capacity to assume a support role in video, particularly caregivers of rural patients, who have more complex care needs and face more issues accessing needed technology than urban patients. To understand the caregiver role supporting older rural patient engagement in video sessions, we conducted interviews with caregivers (N=25) of older rural veterans with an OT video visit. Interview topics included caregivers’ prior use of and general attitudes toward technology, and experiences of the video visit, including set-up and operation of technology and experience participating and supporting patient engagement. Findings revealed a range of rural caregiver perspectives about the role of technology to facilitate patient access to care, including enabling factors which highlighted caregivers’ education and training support needs. This study deepens our understanding of the importance of caregivers to support rural patient access of video sessions, informing development of strategies to optimize caregiver participation.

INCREASED SUPPORT FOR OLDER VETERANS AND THEIR CAREGIVERS USING TELEHEALTH SERVICES

Abstract Five million Veterans live in rural areas in the U.S., and about half of those live in the South. Rural Veterans are more likely to be older and have a disability compared with non-rural Veterans. In Texas, Veterans comprise seven percent of the adult population with a median age of 50 years, of those 17% live in rural areas where access to care is a concern for many Veterans and their families. Technology-based services could help close this gap. The GRECC Connect program is one way to reach rural Veterans and their caregivers. GRECC Connect is a multi-disciplinary virtual geriatrics program that provides support for providers to help manage older, rural Veterans through telemedicine. Patient Tele- consultations follow the Age-Friendly Geriatrics 5 M’s framework (Medications, Mentation, Mobility, Multi-complexity, and what Matters most). As a demonstration project at the San Antonio GRECC, we partnered with the Geriatric Extended Care Services (GEC), and the Dementia Caregiver Program (DCP) to educate and support caregivers. We also partnered with the education department to conduct clinic outreach. In Fiscal year 2022, we served 72 Veterans, 66 of those had a caregiver, and the majority (51/66, 77%) were enrolled in the DCP. In Q4 (17/17, 100%) of caregivers were enrolled in the DCP. In addition, Veterans were referred to 248 additional services including palliative care and saved 5,934 miles. The GRECC Connect program decreases barriers experienced by older rural Veterans including transportation, assistance to navigate VA system and access to specialty geriatric and palliative care.

AGING IN THE RIGHT PLACE: HOUSING AND SOCIAL SUPPORTS FOR OLDER ADULTS EXPERIENCING HOMELESSNESS

Abstract The Aging in the Right Place (AIRP) framework recognizes that secure housing for older adults should support one’s unique vulnerabilities and lifestyles. Applying the AIRP framework to older people experiencing homelessness (OPEH) reveals limited access to the types of living environments and supportive services that promote dignity, health, and inclusion in later life. This symposium aims to use the AIRP framework to examine the places, meanings, and opportunities experienced by diverse groups of OPEH striving to secure housing and promote their well-being. The first paper uses photovoice interviews and thematic analysis to broaden the current conceptualization of AIRP by exploring how feelings, actions, and place inform the meaning of AIRP for older adult residents of one temporary housing program in Vancouver, CA. The second examines the housing and support needs of older adult veterans in Calgary, CA residing in temporary congregate housing through a multi-methods approach involving document reviews, environmental audits, and in-depth interviews. The third paper uses interviews with OPEH and service providers in Columbus, OH to look across the continuum of housing occupied by older adults before, during, and after an episode of late-life homelessness and to investigate the mechanisms that allow OPEH to identify and access the housing they consider optimal. Finally, the discussion positions AIRP for OPEH within the broad context of Age-Friendly ecosystems to highlight the role of coordination between housing providers, government leaders, health services, university researchers, and residents to ensure that AIRP is achievable for precariously housed older persons.

ARE RURAL OLDER VETERANS SATISFIED WITH VIRTUAL COMPREHENSIVE GERIATRIC ASSESSMENTS?

Abstract Rural older Veterans (ROV) have limited access to comprehensive geriatric assessments (CGA). VA Video Connect (VVC) can potentially overcome this access barrier. A standardized process was developed and piloted, to conduct CGAs by VVC. It was found to be feasible and facilitated access to CGAs. The purpose of this study was to assess ROVs’ satisfaction with CGA via VVC. The team developed a 10-item questionnaire with good face and content validity to assess satisfaction with the CGA and process. All ROVs who completed a CGA via VVC were telephoned. They were asked to rate each item on a Likert scale. Caregivers were allowed to assist but the final answer came from Veteran themselves. The results are summarized as percentage of respondents who “agree” or “strongly agree”. ROVs also provided comments. Of the 79 ROVs who completed the CGA via VVC, 63 OVs completed the questionnaire. Most were white (82.8%) males (95.4%), with mean(±SD) age 75.7(±6.5). Most felt it was easy to communicate with the providers (95.2%) and understood the information they were given (98.4%). Most felt comfortable using the technology (75.8%) and that the visit was private enough (96.8%). Although many commented they would prefer in-person visits, most agreed that they would do virtual visits again if offered (71.4%). Overall, they “agreed that they would not change anything about the CGA process (95.2%). The results suggest that ROVs were satisfied with CGA via VVC. More research is needed to determine the outcomes, benefits, and limitations of CGAs performed by VVC.

HOW DOES EXECUTIVE FUNCTION IMPACT ADHERENCE AND COMPLIANCE TO NOVEL PHYSICAL THERAPY INTERVENTION AMONG VETERANS?

Abstract Executive function problems may make it difficult for a person to adhere to and comply with Physical Therapy (PT) treatment. This study examined adherence and compliance to a novel PT intervention among Veterans with and without executive function deficits (EFD+/EFD-). This study was a preplanned secondary analysis of an ongoing Randomized Controlled Trial among middle to older Veterans (≥50yrs) with slow walking speed. Participants’ adherence (dropouts) and compliance (attendance, post-treatment exercise) to 8-week PT treatment were evaluated based on their baseline EFD status. Seventy-two participants were included in this study (mean age 72) and 22% (n=16) were EFD+. Veterans with EFD+ at baseline had worse mobility both objectively (Short Physical Performance Battery, 7.7 ± 1.9 vs. 9.5 ± 2.2, p< 0.01) and subjectively (Activity Measure for Post-Acute Care (AM-PAC), 57.6 ± 4.7 vs. 62.2 ± 5.7, p< 0.01). Dropout rates for EFD+ and EFD- were 44% and 25%, respectively. In the multivariable logistic regression, dropouts were associated with pain interference, depressive symptoms, mobility, and living alone. There were no differences in treatment attendance or post-treatment exercise compliance based on EFD status measured by number of attended sessions or number of post-treatment exercise days. In conclusion, EFD+ was associated with poor mobility and higher rates of dropping out. Screening for EFD is critical and may assist in predicting individuals who will need more support to enhance mobility.

OLDER ADULTS’ ACCEPTANCE OF TELEGRACE: A HYBRID TELEHEALTH CARE MODEL

Abstract The VA Geriatric Resources for Assessment and Care of Elders (GRACE) at Veterans Health Indiana is an interdisciplinary, home-based program providing comprehensive geriatric assessment and ongoing care management for community-dwelling older Veterans’ experiencing geriatric syndromes. TeleGRACE is an extension of the GRACE program and delivers care via a hybrid, telehealth home visit. The TeleGRACE technician operates the audio-visual equipment in the patient’s home while the clinical dyad (GRACE nurse practitioner and social worker) conducts the assessment. The specific aim of this study was to evaluate patient acceptability of TeleGRACE. We conducted a mixed methods study which included Likert-scale ratings and open-ended interviews. Participants used a 5-point scale to indicate agreement (5) to disagreement (1) regarding the acceptability of program elements ratings including ease with technician and virtual dyads; access; and clinical telepresence. The sample included 12 Veterans (mean [M] age, 78.7 years; standard deviation [SD] 7.5) who completed both an initial and follow-up TeleGRACE visit. Veterans reported high agreement of TeleGRACE acceptability (M=4.9, SD=0.3). They agreed: TeleGRACE hybrid visits helped them get care that they could not access otherwise (M=4.7, SD=0.65), they were as well taken care of by TeleGRACE virtual clinicians as those met at in-person visits (M=4.8, SD=0.4), they could hear (M=4.8, SD=0.6) and see (M=5.0, SD=0) the clinical dyads through the video visits, and they were able to ask direct questions of the TeleGRACE clinical staff (M=5.0, SD=0). These results indicated that TeleGRACE’s key elements of a hybrid telehealth home visit were acceptable to older, community-dwelling Veterans.