Tailoring Rehabilitation to the needs of Older Adults with Cognitive Impairment and Dementia

PROJECT ABSTRACT Outpatient physical therapy use is common among older adults who have Alzheimer’s Disease and Related Dementia (ADRD). Unfortunately, physical therapist approaches in this setting do not effectively address the needs of this growing population that has a substantially elevated risk for disability, morbidity, and mortality. Physical therapists in the outpatient setting are in significant need of tools to identify and manage ADRD. The purpose of my National Institute on Aging K76 Career Development Award is to develop a toolbox that improves physical therapy services delivery for older adults with ADRD. In the proposed award, I will leverage Harmonized Cognitive Assessment Protocol (HCAP) data in the Health and Retirement Study to identify domains of cognitive function that should be targeted with the rehabilitation toolbox (AIM1) and use qualitative methods to define barriers and facilitators to physical therapy service delivery for older adults with ADRD (AIM2). I will then use an iterative human-centered design approach to develop the refined rehabilitation toolbox for working with older adults who have ADRD (AIM3). Using a human-centered design with multiple stakeholder groups and the substantial formative knowledge gained from AIM1 and AIM2 will facilitate rapid toolbox development while optimizing acceptability, feasibility, and potential for future outpatient rehabilitation practice implementation. The study aims are tightly aligned with my training objectives, which are to: 1) apply advanced epidemiology and health services research skills in aging populations; 2) develop effective rehabilitation-focused interventions for older adults with ADRD; 3) become an expert in implementation science and pragmatic clinical trial design; and 4) enhance skills in dissemination, grant writing, and leadership. Together, my study aims and career objectives will accelerate my progress toward becoming a leader whose work improves the health, disability, and quality of life of older adults with ADRD. The proposed K76 career development award will set the foundation for an NIH R01 that will test the effectiveness of the refined toolbox in rehabilitation service delivery for older adults with ADRD.