Interventions to address polypharmacy and improve adherence are insufficient for community-dwelling older adults. To examine the feasibility, acceptability, and preliminary efficacy of a tailored medication management intervention (TIMM) to decrease inappropriate polypharmacy and improve medication management in community-dwelling older adults. We completed a single-blind, parallel-group randomized controlled trial. The intervention group received TIMM, including a comprehensive medication review by a pharmacist and an in-home intervention by an occupational therapist. About 78.8% of participants completed the study (n = 26). TIMM participants adhered to treatment recommendations from the occupational therapist (94%) and pharmacist (58%). At 6 months, TIMM participants experienced a significant reduction in medication management barriers (p < .01) and improvement in performance (p < .01). No significant differences were found between groups in reducing inappropriate medications (p = .302) or adherence (p = .458). TIMM is a feasible and acceptable intervention for community-dwelling older adults. It reduces barriers to medication management and improves medication management.

Community engaged research is an approach that embraces partnerships between researchers and their communities that encourages research designed for dissemination and implementation. This session describes the continuum of community-engaged research used by the Stark Lab in St. Louis: community partnerships, participant advisory boards, and a community-based research network and how each of these has improved the quality, applicability, and translatability of research done in the Lab related to fall intervention, home modifications, and social participation. Benefits of these approaches for the Lab include higher participant recruitment rates for studies, better cultural competence of research team members, increased university-community trust, ability to tailor and adapt interventions to meet different community needs, intensive community-engaged skill-building for students and trainees. Benefits for community partners include improved community knowledge and capacity, greater readiness to adopt interventions (e.g. fall prevention programs), reduced gaps in service delivery, improved communication between community based organizations, and increased access to evidence and training. Challenges include time, funding, and availability for university and community-based partners. However, benefits far outweigh challenges and solutions such as building funding to support these efforts into grant funding is helpful.

Occupational therapy (OT) plays an important role in ensuring safe and accessible home environments for aging populations. The Home Hazard Removal Program (HARP) is an OT intervention designed to reduce falls. Initially developed through pilot studies that assessed the feasibility, HARP advanced to clinical trials. Subsequently, the program was implemented within the Long-Term Services and Supports (LTSS) network, demonstrating its scalability and effectiveness in community settings. The current phase of HARP development involves its adaptation for individuals aging with long-term disabilities, addressing the complex needs of a diverse aging population. This series of studies, progressing through the translational continuum, underscores the importance of interdisciplinary collaboration and team science in the development and dissemination of innovative OT interventions. Collaborative efforts among occupational therapists, gerontologists, public health experts, and other stakeholders have been integral to refining HARP’s methodology and achieving measurable improvements in home safety outcomes. These findings provide a valuable roadmap for emerging scholars and professionals seeking to implement evidence-based strategies in gerontology and occupational therapy. This presentation delineates the evolution of HARP through pilot testing, clinical trials, and LTSS network implementation and describes barriers to implementation.

Alzheimer disease (AD) remains a significant global public health challenge, requiring robust multimodal datasets to elucidate its prolonged preclinical phase, improve early detection, advance understanding of disease trajectories, and guide intervention strategies. To address this, the Charles F. and Joanne Knight Alzheimer Disease Research Center (Knight ADRC) at Washington University in St. Louis established the Knight Alzheimer Research Imaging (KARI) dataset. This paper characterizes this dataset emphasizing its phenotypical depth and longitudinal scope, detailing comprehensive multimodal neuroimaging from 1,645 participants (aged 42-97) across 6,217 acquisitions. Spanning the AD spectrum from healthy aging to symptomatic disease, the cohort undergoes extensive longitudinal imaging using structural and functional magnetic resonance imaging (MRI) alongside positron emission tomography (PET) tracers for amyloid and tau pathology. This is complemented by rich clinical, cognitive, genetic, and biomarker data. In addition to raw imaging, the dataset provides quality-controlled processed outputs, including anatomical segmentations and biomarker quantification. By making this data accessible to researchers, the Knight ADRC aims to accelerate discoveries in pathophysiology, biomarker identification, and therapeutic development.

This session discusses future directions for bridging aging and disability research, building from their work published in a special issue of The Gerontologist. The first presenter will provide a historical overview of efforts to bridge aging and intellectual disability, discussing trends in population aging, research and policy initiatives that have forwarded bridging over time, and examples of evidence-based knowledge and practice interventions that demonstrate realized outcomes of bridged aging and disability research such as future planning and health promotion and areas where more bridged research is needed including areas of family support. The second presenter will discuss the TechSage Technology Intervention Model, which designs for the intersection of aging and disability, emphasizing interdisciplinary problem solving. Looking forward to new technologies, opportunities and challenges to utilizing this model and implications and recommendations for bridging aging and disability research will be identified. The third presenter will discuss the evolution of aging and disability research over time, conceptual and methodological challenges to engaging in research that bridges aging and disability domains, and opportunities for reconciling these to support future bridging work. The session’s discussant will reflect upon where bridging work goes from here by highlighting gaps that need to be addressed, examples of success, and considering how researchers can more actively engage in bridging research work. Lifelong Disabilities Interest Group Sponsored Symposium

Background: Home hazard removal programs are effective in reducing falls among older adults, but delivery in the United States is limited. Objectives: We completed a process evaluation of the Home Hazard Removal Program (HARP), an intervention delivered by occupational therapists. Methods: Using the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), we examined outcomes using descriptive statistics and frequency distribution. We examined differences between covariates using Pearson correlation coefficients and two-sample t tests. Results: 79.1% of eligible older adults participated (reach); they experienced a 38% reduction in fall rates (effectiveness). Ninety percent of recommended strategies were completed (adoption), 99% of intervention elements were delivered (implementation), and 91% of strategies were still used at 12 months (maintenance). Participants received an average of 258.6 minutes of occupational therapy. An average of US$765.83 was spent per participant to deliver the intervention. Conclusions: HARP has good reach, effectiveness, adherence, implementation, and maintenance and is a low-cost intervention. Plain Language Summary Home hazard removal programs can prevent falls for older adults but are not standard practice in the US. The Home Hazard Removal Program (HARP) is a fall prevention program for older adults delivered by an occupational therapist (OT) who works with the participant to identify hazards and find strategies to resolve them. We completed a randomized controlled trial to test HARP's effectiveness in reducing falls. This paper describes a process evaluation in which we looked at the additional outcomes of reach, adoption, implementation, maintenance, and cost. Almost 80% of eligible individuals participated (reach), and 90% of recommended strategies were carried out (adoption). Study OTs delivered 99% of the intervention elements (implementation), and 91% of strategies were still in use after 1 year (maintenance). HARP cost an average of $765.83 per participant. HARP is a low-cost fall prevention program that can be delivered among community-dwelling older adults in the US.

Background Increasing older adults’ awareness of their personal fall risk factors may increase their engagement in fall prevention. The purpose of this study was to explore the impact of and participant satisfaction with a comprehensive occupational therapy fall risk screening and recommendations for evidence-based fall prevention strategies based on personalized fall risk results for community-dwelling older adults. Methods Cognitively normal participants (Clinical Dementia Rating = 0) were recruited from an ongoing longitudinal study of memory and aging. Participants completed 2 annual in-home visits, fall risk questionnaires, and 12 months of fall monitoring between visits. Participants received a health report card with their fall risks and tailored recommendations in 6 domains. Participants completed follow-up questions at their next annual in-home visit about the fall risk recommendations and their satisfaction with receiving their fall risk results. Results Two hundred five participants completed 2 annual visits and 12 months of fall monitoring. Of the 6 domains of recommendations provided, participants were most likely to follow through with getting an annual eye exam and reviewing their medications with their doctor or pharmacist. Older adults who fell were significantly more likely to receive recommendations for finding fall prevention classes ( p = 0.01) and having a doctor or pharmacist review their medications ( p = 0.004). The majority of participants were satisfied receiving their fall risk results (92%) and believed it to be beneficial (90%), though few participants shared their results with their doctor (20%). Conclusions An occupational therapy fall risk screening and tailored recommendations were not sufficient to encourage follow through with fall risk recommendations. Older adults may benefit from additional support and encouragement to reduce their fall risk. Additional research is needed to examine awareness of fall risks and follow through with fall risk recommendations among community-dwelling older adults.

Abstract Falls are the leading cause of injury, institutionalization, and injury-related mortality among older adults. As the older adult population is expected to grow exponentially in the next decade, the cost and consequences of falls will continue to rise. While promising fall prevention interventions exist, the death rate due to falls continues to climb. Limited population health effectiveness of these interventions may be attributable to a poor understanding of contributing factors to falls, such as the environmental and contextual circumstances in which falls occur. The objective of this study was to characterize the circumstances of falls among community-dwelling older adults. We completed monthly, prospective fall monitoring with 350 cognitively normal (Clinical Dementia Rating=0) older adults for up to four years. Standardized interviews were conducted to gather the circumstances of all reported falls, including the location, time of day, and activity at the time of the fall. We qualitatively analyzed fall interviews to determine the reason for the fall and factors of limited or divided attention preceding the fall. There were a total of 1,133 falls reported by 212 (61%) participants. The majority of falls occurred outdoors (53%), in the afternoon (45%), while walking or running (50%), and due to tripping over or catching feet on an object (37%). Additionally, 37% of falls occurred during instances of limited or divided attention. Taken together, these findings provide a greater understanding of the circumstances of older adult falls that may inform future classifications of types of falls and lead to tailored fall prevention approaches.

PURPOSE:To examine the effects of leisure participation on mental health for middle-aged and older adults with physical disabilities. MATERIALS AND METHODS:A systematic review conducted in March-May 2022 with an updated search in February 2024 retrieved data from MEDLINE, CINAHL, PsycInfo, and EMBASE. Inclusion criteria included a study population with a mean age ≥45 years and with physical disability, and original, peer-reviewed literature. Exclusion criteria included non-community-dwelling participants, participants outside the specified age range, review studies, intervention studies not focused on leisure or intrinsically motivated activities, and studies without full text. The Oxford 2011 Levels of Evidence, NIH study quality assessment tool, and Cochrane ROBINS-I tools were used to assess the evidence strength and the risk of bias. A data extraction table was created to analyze and synthesize the results. RESULTS:Eleven articles with 18,681 total participants were thoroughly reviewed. Most studies were longitudinal survey, cohort, and cross-sectional studies. Evidence indicates that leisure participation benefits mental health (depression, anxiety, happiness, and well-being) and other health-related outcomes. CONCLUSIONS:Findings should be interpreted with caution due to lack of high-level evidence. Future research should consider alternative study designs in addition to RCTs to better capture the individualized nature of leisure activities.

The purpose of this scoping review was to characterize the nature and scope of existing literature on the role of built environments in the community participation of adults aging with physical disabilities (AAwPD). A scoping review was selected to identify the volume and types of evidence available, pinpoint knowledge gaps, and clarify key concepts. Twenty-one articles were included for review, all of which were published within the last 20 years and identified components of the built environment for intervention. Results demonstrated the need for investigators to identify common indicators, use a shared lexicon, and improve dissemination of results across disciplines.

Introduction: People ageing with long-term physical disabilities face unique challenges to maintaining independence. We developed a novel, evidence-based intervention - Removing Environmental Barriers to Independent Living - to support participation and reduce falls.Methods: To examine Removing environmental barriers to independent living's feasibility and estimate its magnitude of efficacy, we conducted a single-blinded randomised controlled trial. Fifty participants who were aged 45-65 years with a physical disability for at least 5 years were randomised to intervention (n = 24) or control (n = 26). Activity performance, environmental barriers to performance, community participation, environmental fall hazards and fall prevention behaviours were assessed at baseline and at 6-month follow-up. Dose, adherence, fidelity and cost were examined. Linear mixed-effects models for repeated measures were used to assess the effects of time, group and group by time interaction on the continuous outcomes.Results: Removing environmental barriers to independent living had high fidelity and adherence and a low implementation cost. There were trends for greater improvements in activity limitations and activity performance among intervention versus control participants.Conclusion: Removing environmental barriers to independent living is a feasible intervention with high fidelity and adherence. Findings trended towards greater improvements in activity performance for intervention participants. Results could inform future planning for a larger pragmatic trial.

Research ObjectivesTo evaluate a set of 9 activity domain measures to broadly assess community participation and change in participation over time for persons aging with disability.DesignA cohort study with repeated measures three times annually (T1, T2, T3) between 2019-2022.SettingThe general community.ParticipantsA community-based sample (N=323) of persons ages 45-65 responded to a survey. The cohort is majority female (68.7%) and single (61.9%), and over one-third (34.3%) is non-White.InterventionsNot applicable.Main Outcome MeasuresNine activity domain measures were developed based on extant research and evaluated with assistance from community-based support service providers. For each activity domain, 5 questions were asked regarding participation in the domains of activities and the quality of participation (satisfaction with time spent, changes in participation, and barriers and facilitators of participation). Participants were asked if they thought changes were attributable to aging, the COVID pandemic, or other factors.ResultsFindings showed varying levels of participation across the 9 activity domains, with the lowest participation rate for employment and the highest participation rates for personal leisure and managing medications across T1, T2, and T3. Participants wished they spent more time engaging in exercise, employment, exterior and interior chores, community leisure, social activities, and civic and religious activities and less time managing medical conditions, doing interior chores, and engaging in leisure at home. Change in participation over the 3-year period was limited; most change was reported as activity reduction. In general, respondents indicated that reduction was due to their aging or the COVID-19 pandemic. Personal assistance, transportation, environmental modifications, and improved health were identified as factors needed to help increase participation levels.ConclusionsCharacterizing participation is an important element of delivering effective community-based care. We concluded that the activity domain measures demonstrated efficiency in identifying participation rates and change. Community-based organizations may deem them useful for assessing support and service needs to facilitate participation.Author(s) DisclosuresNo conflicts to disclose.

Background Loneliness has been associated with several consequences, including increased risk of developing Alzheimer disease (AD). Loneliness may arise during the preclinical phase of AD, but little is known about the relationship between loneliness and amyloid accumulation consistent with preclinical AD. Therefore, the purpose of this study was to examine the relationship between amyloid accumulation and subjective experiences of loneliness among cognitively normal older adults during the COVID-19 pandemic. Methods A global Clinical Dementia Rating ® Scale score of 0 was required for enrollment. Cortical amyloid burden was measured using [11C] Pittsburgh compound B or [18F]-Florbetapir PET tracers. Centiloids were used to synchronize measures. Demographic characteristics and measures of loneliness, anxiety, and depression were collected via self-report. Multiple linear regression was used to examine the relationship between loneliness and amyloid accumulation. Results The 108 participants had a mean age of 75.0 and an average amyloid accumulation of 22.2 ± 31.9. Mean UCLA Loneliness Scale scores were 31.6 ± 10.8. A significant positive association was detected between loneliness and amyloid accumulation (β = 0.064, SE = 0.027, 95% CI = [0.011, 0.118], p = 0.018). Conclusions These findings highlight the relationship between higher amyloid accumulation and greater loneliness during the COVID-19 pandemic. Healthcare professionals should include routine assessments for characteristics of loneliness in routine clinical evaluations and integrate loneliness reduction and prevention treatments among older adults experiencing loneliness. Additional research is needed with a larger, more diverse sample to examine the relationship between loneliness and amyloid accumulation.

Abstract Change in social participation over time among mid-life adults with disabilities as they grow older is under-studied. Existing research indicates that social participation among persons with disabilities, younger and older, is positively associated with health and well-being outcomes including mental health and life satisfaction. Despite this knowledge, few studies have explored if and how social participation changes year to year, and how symptoms of aging with disability including pain, fatigue, and depression may influence those changes. We undertook a cohort survey (2019-2021) with a sample of adults aged 45-64 (N=323) with self-reported mobility disability, collecting data over three annual time points, in order to better understand if we could see annual change in social participation that could help inform early interventions to support and sustain social participation. Our results found that T-scores from PROMIS measures of physical function, depression, and pain changed little over time, but level of fatigue did significantly change. PROMIS T-scores of satisfaction with social roles and activities and did not change over time, but T-scores for ability to participate in social roles and activities increased over time. T-Scores for physical function, depression, fatigue, and pain were significantly associated with both participation outcomes. In qualitative data, most participants (63%) said their participation declined over the 3 years, attributing change to health, aging with disability symptoms, and the COVID-19 pandemic. Study limitations include potential effects of the COVID-19 pandemic on participation and disability/health. Findings suggest the need to consider aging with disability symptoms when evaluating participation interventions.

Abstract A critical issue for bridging aging and disability research is developing a shared understanding of when disability should be employed as an independent or a dependent variable. To date, this discussion has rarely been had across researchers. Is disability a dependent variable, an outcome? Or does it contribute to outcomes as an independent variable? Or both? How disability is conceptualized, measured, analyzed, and interpreted matters for how we understand the role disability plays over the life course. Disability status is used as both an independent and a dependent variable in gerontological and disability/rehabilitation research. Research in both fields often focuses on reducing likelihood, duration, and severity of disability. A key distinction between fields is how each conceptualize disability – what it is and what it means – particularly given age of onset and type of disability. For example, in gerontological research, often positions disability as an individual trait that mediates the ability to live independently (typically reducing independence). However, disability/rehabilitation research commonly positions disability as a situational trait, or moderating variable associated with difficulty of living independently, but not causing inability to live independently. NIH’s recent inclusion of disability as a social determinant of health provides an opportunity for gerontologists to more deeply consider how disability is employed in research designs and why. We discuss how more consistent use of disability as an independent and/or dependent variable can help bridge aging and disability research and provide greater understanding of the role disability plays over the life course.

Barriers to learning after a stroke may prevent stroke survivors from acquiring helpful information regarding stroke prevention and preparedness. The objective of this study was to evaluate the efficacy, feasibility, and acceptability of a novel in-home stroke education program for survivors in the acute phase following a stroke. Study participants completed 4 in-home education sessions about stroke prevention and preparedness following their discharge home from inpatient rehabilitation. Sessions were designed to be completed within an 8-week period. Sessions were presented with evidence-based teaching methods and could be tailored to individual needs. Participants completed short quizzes before and after each education session to measure knowledge attainment. Forty-nine participants were included in this study. On average, the program was completed in 10 weeks, or 69.5 days (SD = 29.6), and visits lasted 66.26 minutes; 81.5% of participants completed Visit 1, 77.5% completed Visit 2, and 73.5% completed Visits 3 and 4. Statistically significant changes from pretest-to-posttest scores were found for all races and genders and for ages 50 to 79. There was no significant change in pretest-to-posttest scores for participants over age 80 (n = 3). Results show that delivering a stroke education program can be accomplished, on an expanded timeline. The program was effective in increasing stroke knowledge for participants recently discharged from inpatient rehabilitation following a stroke.

Background Adults aging with long-term physical disabilities (AAwPD) face personal and environmental barriers to living independently, but little is known about their perspectives on and experiences with physical activity (PA). Purpose The purpose of this study was to explore the perspectives of AAwPD on PA. Research Design Qualitative semi-structured interviews with AAwPD were conducted virtually via phone or videoconference. Study Sample A convenience sample of AAwPD aged 45-65 and living with a physical disability for at least 5 years was recruited through aging organizations, disability organizations, and social media in St. Louis, Missouri until thematic saturation was reached (n = 20). Data Collection and Analysis Participants were asked semi-structured interview questions about their perspectives and experiences with PA following an interview guide developed by disability, aging, and qualitative research experts. Data were analyzed using text analysis in NVivo 12. Codes were developed into themes by the research team and validated using member checking methods. Results Four themes emerged from the data: barriers and facilitators to engaging in PA, motivations and beliefs regarding PA, benefits of PA, and PA routines and habits. Participants reported a desire to engage in more PA but described barriers such as pain and fatigue symptoms, secondary health conditions, lack of social support, and fear of falling. Accessibility of facilities and equipment (eg, lack of ramps or equipment not at wheelchair height) and transportation barriers (eg, inconvenient schedules or excessive wait times) were specifically described as major environmental barriers. Conclusion Most participants' reported PA routines did not meet the quantity or intensity levels recommended by current guidelines. These results may help inform healthcare providers, community programs, and future interventions to improve PA levels for AAwPD, an underserved but growing demographic.