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Current Research Projects

Aging & Technology

ASSESSING THE UTILITY OF DEMENTIA PATIENT MONITORING TECHNOLOGY

(2018–2020)

Persons living with dementia (PWD) who wander due to disorientation and underlying agitation are at increased risk for harm due to being in an unsupervised environment, which can increase the burden of care for family caregivers. This pilot study, funded by the Texas Alzheimer’s Research and Care Consortium, aims to test the feasibility of a multi-component intervention that integrates a technology-based approach to increase PWD safety with evidence-informed skills training for caregivers. It examines the usability of a specially programmed watch (e.g., amount of time worn by PWD, features used by caregivers) and user satisfaction (e.g., whether it meets user expectations and needs, ease of use, what, if any changes the users would recommend) of the wearable technology that provides location information and two–way communication between caregivers and care-recipients.

GAMEPLAN 4 CARE: WEB-BASED DELIVERY SYSTEM FOR REACH II

(2018–2023)

With an aging population, there is a rapidly growing number of persons with dementia, and concerns about burdens placed on family caregivers. This NIH-funded research applies technology to an existing evidence-based intervention, Resources for Enhancing Alzheimer’s Caregiver Health II (REACH II). The goal is to create a scalable and sustainable online family caregiver support system to be accomplished through two study aims: (1) advance the current proof-of-concept GP4C into a viable delivery system for the REACH II intervention; and (2) compare the relative impact of GP4C and GP4C-Education on a wide range of family caregiver outcomes. GamePlan4Care is a novel multifaceted intervention concept tested in a previously funded Texas Cares grant. Working collaboratively with colleagues at Baylor Scott and White Health who are designing and implementing GamePlan4Care, Center investigators are responsible for evaluation.

IMPROVED AD/ADRD ASSESSMENT SENSITIVITIES USING A NOVEL IN-SITU SENSOR SYSTEMS

(2019–2023)

The ability to perform various daily functions is an established predictor of cognitive decline in older adults and a useful predictor in independent living and functioning. This fast-track SBIR project funded by the National Institute on Aging addresses the critical need for better assessment tools in dementia research and care. The primary objective is to demonstrate the feasibility and effectiveness of using the Birkeland Current Sovrin IoT system to continuously and accurately assess daily functions, ADLs, and IADLs, for persons experiencing cognitive decline in a home or assisted care setting. Texas A&M is serving as the academic partner and will facilitate input from the advisory group as well as oversee the evaluation. Phase 1 has been completed, and the project has moved to phase 2 where CPHA will play a major role in assessing the comparability of the traditional survey periodic health professional measurement approach to the newer technological noninvasive real-time monitoring of ADL functioning.

An interface design for older adults living with cognitive impairments to use automated vehicles

(2021–2022)

Current automated vehicles (AV) and in-vehicle technologies are not designed to support older adults with cognitive impairment. The objectives of this multidisciplinary study are to (1) develop a user interface for older adults with mild to moderate cognitive impairment to be used in AVs, and (2) evaluate the effectiveness of the interface on the mobility of older adults. Evaluation methods include online surveys, focus group meetings, and phone interviews with caregivers and older adults with mild to moderate cognitive impairment to understand their perception of AVs, suggestions to improve the mobility of older adults with mild to moderate cognitive impairment, and preferences regarding the interface design concept and its usability. The outcomes of this study will lay the foundation for an accessible human-machine interface for AVs, improve the mobility of older adults with mild to moderate cognitive impairment, and increase passenger vehicle accessibility.

Exploring the Safety Impacts of the Older Population’s Access to Autonomous Vehicles (AV) and Telemedicine: A Real-World Experiment in a Small and Rural Community

(2020–2021)

Part of the Safety through Disruption University Transportation Center, this project marks the first attempt to conduct a real-world assessment of AV’s potential safety impacts as a disruptive technology to offer older adults a pathway to continued independent mobility in underserved communities. Collaborating with industry partners, we will explore how older adults can more safely transit and get access to health care with a “2-in-1” (taxi + telemedicine) service delivered via AV. The perceived and objective safety impacts of this novel service will be explored along with changing travel patterns and reduced healthcare trips.

Technology for Caregiving Assessment Research & Education Services

(2020–2022)

Alzheimer’s disease and related neurocognitive disorders are progressive conditions that can, in some cases, cause agitation, wandering, and repetitive motor behaviors. Persons living with dementia (PWD) who wander and become disoriented, are at an increased risk for harm due to being in a non-supervised environment and can increase the burden of care for family caregivers. Reducing the safety risk of PWD and their family caregivers can be achieved via evidence-based approaches (Gitlin et al, 2015). Yet, current evidence-based approaches have not focused on PWD living in family homes, nor have they taken advantage of state of science technology that has the potential to maintain the health and safety of PWD. Moreover, technology-based solutions to wandering and elopement have not been systematically tested as a way to reduce the burden of care reported by family caregivers. Thus, there is a critical need to test the viability of currently available technology-based approaches within the family home and community setting of the PWD to increase the autonomy of the PWD while reducing the day-to-day caregiving burden of the family caregiver. The overall goals of this project are to assess user feedback and impact (from the perspective of both the PWD and their family caregivers) of an innovative, interactive wearable device, the Theoracare/GPS watch concern about wandering), and the quality of caregiver/care-recipient interactions.

Aging & The Built Environment

DEMENTIA FRIENDLY COMMUNITIES TO PROMOTE ACTIVE LIVING

(2018–2021)

Little is known about the role of different environmental domains (e.g., built, natural and social) on physical activity, social interaction, and overall independence of persons with dementia. Funded through the National Institute on Aging as an administrative supplement to an ongoing NIH study of environmental impacts on physical activity, this project has three specific aims, centered on advancing the understanding of various housing and neighborhood environments for persons with AD/ADRD. By identifying the significant barriers and facilitators in the built, natural, and social environments in which people with AD/ADRD live, and by collaborating with dementia experts and built environmental professionals, this research aims to identify environmental strategies to promote physical activity, social interaction, and independence of people with AD/ADRD and reduce burdens on their caregivers. This project will be utilized to refine study protocols and obtain pilot data for more extensive research in this understudied area.

FIGHTING OBESITY BY REINVENTING PUBLIC TRANSPORTATION: A NATURAL EXPERIMENT

(2018–2023)

The use of public transit has been associated with increased physical activity and is considered a promising approach to reducing the risk of obesity and other age-related chronic conditions such as cancer, diabetes, and heart disease. This timely study uses a pre-post case comparison design to examine the causal impact of Bus Rapid Transport (BRT) and other supporting strategies on residents’ physical activity. The specific aims are to (1) determine physical activity impacts of BRT; (2) examine physical activity impacts of specific implementation strategies, including education (e.g., lifting the knowledge barrier by offering a smartphone app and training to assist transit trip scheduling) and modifying cost (e.g., lifting the financial barrier to transit use by executing an introductory free-fare strategy); and (3) explore benefits and costs of BRT implementation and barriers and facilitators of BRT use.

PHYSICAL ACTIVITY IMPACTS OF A PLANNED ACTIVITY-FRIENDLY COMMUNITY (AFC)

(2015–2021)

With a multidisciplinary investigative team representing public health, architecture, engineering, computer sciences, and education, this NIH-funded longitudinal, case-comparison study will examine how an activity-friendly community, which embodies the best practices in environmental design and policy, can increase residents’ levels of physical activity and influence when and where they are physically active. It will also provide insights into why environmental and psychosocial factors influence physical activity, and how place impacts lifestyle behaviors related to the burden of obesity. The specific aims are to (1) examine the short-term and long-term changes in total PA levels and spatial and temporal patterns of physical activity after sedentary or insufficiently active individuals move from non-AFCs to an AFC; and (2) determine what built and natural environmental factors lead to changes in physical activity among these populations, either directly or indirectly by affecting psychosocial factors related to physical activity.

COVID-19 for Vulnerable Populations: Longitudinal Study on Evolving Community Impacts among Affordable Housing Residents and Roles of Physical and Social Environments

(2020–2021)

With the spread of COVID-19, there is a timely need to understand the impacts of COVID-19 using new assessment tools. Texas A&M University School of Innovation is supporting a project to understand: (1) how COVID-19 affects the daily living and health of affordable housing residents in Austin, Texas, and (2) how physical and social environments help or deter the COVID-19 coping process in this vulnerable, high-risk population. This project will assess the impacts of COVID-19 on residents’ daily life and health using Ecological Momentary Assessment, a data collection method that repeats sampling of subjects’ behaviors and experiences in real-time, in their natural environments.

WORKING ON WELLNESS: PROMOTING PHYSICAL ACTIVITY THROUGH TACTICAL URBANISM

(2019–2021)

Alarming rates of obesity are a persistent public health challenge in Hidalgo County, Texas. Since 2015, Working on Wellness (WoW) coalitions in Hidalgo County have collaborated to develop and implement policy, systems, and environmental (PSE) interventions that address environmental determinants of obesity. This project will serve as a training laboratory for students to design and implement a community intervention that addresses gaps in the built environment to create an environment that supports physical activity. Public health students will have an opportunity to collaborate with WoW coalition members, transportation planners, urban planning students, and public health faculty to develop and implement a pop-up demonstration project that utilizes tactical urbanism strategies to enhance and increase physical activity opportunities for healthy living.

Health & Chronic Disease management

At the Intersection of Health and Place: Barriers and Facilitators of Health Service Utilization among Men with Chronic Conditions

(2018–2020)

This project advances understanding about inequities associated with men’s utilization of health services for disease self-management. This project collected data using an internet-delivered survey to collect data from over 2,000 Black and Hispanic men about their service utilization and perceived barriers/facilitators to disease self-management. Findings from this project will inform future multi-level interventions to improve disease self-management among men and reduce sex-based disparities in terms of life expectancy. To date, a series of 10 analyses have been performed to drive conference presentations, peer-reviewed publications, and grant proposals.

Dementia Connections: Expansion of Dementia Specific Case Management

(2019–2021)

Given the aging of the population, there is an urgent need to provide better, more responsive services for individuals with Alzheimer’s disease and related dementias and their families. The purpose of this project is to conduct a rigorous evaluation of the Dementia-Specific Case Management program. With continued funding from the Administration for Community Living, the program expansion will include: (1) improved efficiencies in service provision to better address unmet needs; (2) addition of a medication management program (HomeMeds) and medical case reviews to reduce individual’s adverse health events; and (3) planned collaborations (e.g., community organization, an integrated health system; and an academic health care center) to provide necessary referrals and information to make the business case for the dementia-specific care management model.

Evidence-Based Programs and Healthcare Utilization in Florida

(2018–2021)

This project works at the nexus of community-based organizations, insurance agencies, and managed care organizations to assess the financial returns on investment (ROI) for delivering evidence-based programs for patients in Florida. Through a series of pilot studies, retrospective and prospective healthcare utilization and costs for older adults were examined before and after participating in the programs to identify associated health improvements. The most predominant study resulting from this project is the national evaluation of the Program to Encourage Active, Rewarding Lives (PEARLS) to document improvements in depressive symptomology before and after program participation. The intent is to garner additional interest to support these programs in Florida and other areas of the country will increase among healthcare entities.

Health in Motion: A Pragmatic Clinical Trial

(2020–2023)

Many fall prevention programs are costly, lack scalability and uptake, have poor sustainability, lack access for non-metropolitan demographics, or those who are lonely or isolated. The purpose of this grant is to demonstrate: a reduction in cost vs. current practices, scalability, and increase access by reaching demographics not usually represented in fall prevention programs and sustainability by cost-effectively tracking participants well beyond the traditional 8-12 weeks. This project will complete two pragmatic clinical trials to demonstrate the effectiveness of the NIH-funded Health in Motion Fall Prevention Platform. After finalizing the development and testing of the technological platform, these trials will address limitations associated with the face-to-face delivery of evidence-based fall prevention programs when deployed in community centers (study 1) and the home (study 2). 

Putting CDSMP to Work: Implementation of the Live Healthy, Work Healthy Program

(2014–2020)

Employee health and wellness are at the forefront of employers’ minds because a healthy employee is also a productive employee. In collaboration with The University of Georgia, this project translates the Chronic Disease Self-Management Program (CDSMP) for use among middle-aged and older employees with chronic conditions. The workplace-tailored CDSMP (wCDSMP) targets employees with increased cardiovascular risk to improve work performance while maintaining health-related outcomes shown with the original CDSMP. The overall aims of this research project are to examine the influence of CDSMP workshops specifically tailored to workplace settings on health outcomes, work performance, and productivity indicators. Additionally, the project will estimate the costs of implementing the program and assess cost-effectiveness and return on investment for employers and communities.

Virtual Healthy Habits: An Innovative Approach to Nutrition Education, Hands-On Meal Preparation, and Socializing for Older Adults

(2020–2023)

Healthy behaviors are important for successful aging, but more needs to be known about how to deliver a nutrition education that also promotes social engagement. Partnering with the OASIS Institute, CPHA will provide research expertise to help evaluate the effectiveness of the Virtual Healthy Habits program in terms of improving nutrition risk, meal preparation efficacy, and social connectedness. This study will translate the face-to-face Healthy Habits for Adults program into Virtual Healthy Habits, an internet-delivered five-week workshop. The virtual program, combined with meal delivery, includes meal preparation sessions and virtual lunch (like a virtual congregate meal). The purpose is to evaluate the effectiveness of Virtual Healthy Habits in terms of improving nutrition risk, meal preparation efficacy, and social connectedness.

Your Diabetes, Your Heart

It is important that lay people recognize the connection between heart disease and diabetes, and know where to seek resources. Your Diabetes, Your Heart is a free 1.5-hour, the single-session course where you can learn about heart health and diabetes. Sessions are offered online or face-to-face. Ninfa Peña-Purcell received an American Diabetes Association (ADA) Know Diabetes by Heart (KDBH) Community Grant, for the Your Diabetes, Your Heart program. Your Diabetes, Your Heart is a community collaborative initiative that will integrate the ADA’s Know Your Diabetes by Heart educational resources into diabetes self-management education programs. These programs will be offered in virtual/online and face-to-face formats, to improve diabetes and cardiovascular knowledge and self-care skills among people with type 2 diabetes, particularly those in underserved, minority populations.

Education & Training

Engaging Community Health Workers to Increase Pneumococcal Pneumonia Vaccination Update

(2019–2020)

Adult vaccinations while critical for maintaining health are underutilized, especially in ethnic populations. CPHA has entered into a partnership with Pfizer Vaccines to collectively develop training materials targeting community health workers (CHW; also known as promotoras) to guide their interactions with older adults (age 65+) and promote pneumococcal vaccination coverage. The training will focus on (1) the importance of adult vaccination; (2) how to engage older adults and address their concerns and perceived barriers to being vaccinated; and (3) tools that can be used to educate community members, refer them to be vaccinated and organize events.

Falls Infrastructure Expansion and Integration Enhancement (FIE2)

(2019–2022)

Falls prevention programs are being successfully disseminated throughout the nation. Yet, more can be done to ensure that programmatic efforts are meeting the needs of the increasingly diverse older population. Funded by the Administration for Community Living, the purpose of the Falls Infrastructure Expansion and Integration Enhancement (FIE2) is to enhance the integration of the partner network to support the addition of A Matter of Balance to one new urban and five new rural counties and Enhance Fitness (EF) to the array of evidence-based fall prevention programs in the Tarrant County area and six new FIE2 counties. FIE2’s goals are to 1) Provide an array of evidence-based fall prevention programs to increase the number of program participants in rural and urban counties, and 2) Attract healthcare payors through an integrated TH@H network. As the academic partner, CPHA has a subcontract with United Way of Tarrant County to monitor participant recruitment, retention, and outcomes.

No Falls Partnership

(2017–2021)

Falls continue to be a public health problem impacting older adults, their families, health care systems, and the aging services network. Funded by the Administration for Community Living, NFP will enhance the 2015-2017 Falls Reduction Education and Empowerment (FREE) project into an integrated network of 15 partners who will provide screening, referral, and participation opportunities for A Matter of Balance (AMOB). NFP will increase capacity by adding Spanish and Vietnamese AMOB to the current system. NFP’s goals are to (1) increase the number of low-income and minority participants in AMOB; (2) increase the number of AMOB Master Trainers and Volunteer Lay Leaders; (3) increase underserved population by 15%, especially in falls “hotspots”; (4) create sustainable funding throughout integrated health care and managed care partnerships; and (5) utilize geo-mapping to enhance falls prevention infrastructure. Texas A&M serves as the academic partner.

PROBLEM SOLVING TRAINING (PST) FOR ENGLISH- AND SPANISH-SPEAKING CARE PARTNERS OF ADULTS WITH ALZHEIMER’S AND ALZHEIMER’S-RELATED DEMENTIA

(2020–2022)

This project will optimize Problem Solving Training (PST)/Descubriendo Soluciones Juntos (DSJ), an evidence-based and culturally adapted self-management intervention among English- and Spanish-speaking caregivers of persons living with dementia. The purpose is to evaluate these interventions (which can be delivered completely remotely) that were designed to enhance self-efficacy and reduce caregiver burden and depressive symptoms.

Policy & Environmental Assessments & Interventions

TEXAS A&M OPIOID EDUCATION AND NALOXONE ADMINISTRATION

(2018–2020)

While Texas is not known as a high incidence state, there is emerging evidence of an unrecognized opioid-related crisis in Texas. Toward this end, Texas A&M has established an Opioid Task Force which has received pilot funding to develop strategies for better understanding and addressing the epidemic in Texas. Additionally, Texas A&M has received approximately $2 million worth of naloxone kits and will be testing the effectiveness of training university personnel as well as local community leaders in enhancing knowledge about opioids, signs and symptoms of overdose, and effective reversal treatments for saving lives. The task force has educated over 500 participants since October 2019. Community groups have included local law enforcement, first responders, public health districts, as well as county officials.

Texas A&M Triads for Transformation Opioid Epidemic’s Impact on Older Adults

(2018–2020)

While public health officials recognize the devastating nationwide impacts of the opioid epidemic on Americans of all socio-demographic backgrounds, scant attention is paid to the impact of opioid use/misuse among older adults, especially those in rural areas. This preliminary research, funded through the President’s Excellence Award, will: (1) identify older adults who are at high risk of negative impacts due to the opioid crisis; (2) understand the myriad ways in which older adults may be affected; (3) evaluate the costs of the epidemic in terms of needed medical care and social services, both personally and to the health care system; and (4) conduct an environmental scan of effective clinical, educational, behavioral, technological and/or policy solutions for mitigating impacts of the opioid epidemic on older adults and their families. 

Teens Think Smart: A Novel Approach to Preventing Opioid Misuse among Adolescents in Rural Texas

(2019-2020)

The Opioid epidemic has swept through the country in recent years and is part of a larger mental health and substance abuse problem facing community members of all ages. Funded by the Health Resources and Services Administration, this project is a multi-component community-based opioid abuse and misuse prevention intervention targeting 300 rural seventh and eighth-grade students in multiple rural Texas counties. The project will be informed by a community-based participatory methodology, which engages the community through the formation of health coalitions that will participate in a community readiness assessment, and assist with planning and implementing the Teens Think Smart curriculum, engaging school districts, local government, law enforcement, and health entities.