Background: Aging military veterans are an important and growing population who are at an elevated risk for developing mild cognitive impairment (MCI) and Alzheimer dementia, which emerge insidiously and progress gradually. Traditional clinic-based assessments are administered infrequently, making these visits less ideal to capture the earliest signals of cognitive and daily functioning decline in older adults. Objective: This study aimed to evaluate the feasibility of a novel ecologically valid assessment approach that integrates passive in-home and mobile technologies to assess instrumental activities of daily living (IADLs) that are not well captured by clinic-based assessment methods in an aging military veteran sample. Methods: Participants included 30 community-dwelling military veterans, classified as healthy controls (mean age 72.8, SD 4.9 years; n=15) or MCI (mean age 74.3, SD 6.0 years; n=15) using the Clinical Dementia Rating Scale. Participants were in relatively good health (mean modified Cumulative Illness Rating Scale score 23.1, SD 2.9) without evidence of depression (mean Geriatrics Depression Scale score 1.3, SD 1.6) or anxiety (mean generalized anxiety disorder questionnaire 1.3, SD 1.3) on self-report measures. Participants were clinically assessed at baseline and 12 months later with health and daily function questionnaires and neuropsychological testing. Daily computer use, medication taking, and physical activity and sleep data were collected via passive computer monitoring software, an instrumented pillbox, and a fitness tracker watch in participants’ environments for 12 months between clinical study visits. Results: Enrollment began in October 2018 and continued until the study groups were filled in January 2019. A total of 201 people called to participate following public posting and focused mailings. Most common exclusionary criteria included nonveteran status 11.4% (23/201), living too far from the study site 9.4% (19/201), and having exclusionary health concerns 17.9% (36/201). Five people have withdrawn from the study: 2 with unanticipated health conditions, 2 living in a vacation home for more than half of the year, and 1 who saw no direct benefit from the research study. At baseline, MCI participants had lower Montreal Cognitive Assessment (P<.001) and higher Functional Activities Questionnaire (P=.04) scores than healthy controls. Over seven months, research personnel visited participants’ homes a total of 73 times for technology maintenance. Technology maintenance visits were more prevalent for MCI participants (P=.04) than healthy controls. Conclusions: Installation and longitudinal deployment of a passive in-home IADL monitoring platform with an older adult military veteran sample was feasible. Knowledge gained from this pilot study will be used to help develop acceptable and effective home-based assessment tools that can be used to passively monitor cognition and daily functioning in older adult samples.
Bibliographical noteFunding Information:
The authors would like to thank their colleagues, research assistants, technicians, programmers, analysts, and volunteers who invited them into their homes and lives. This work was supported by pilot project CX001669-01 from the US Department of Veterans Affairs Clinical Science Research and Development Service The contents do not represent the views of the US Department of Veterans Affairs or the United States Government. This research was also supported in part by the Collaborative Aging-in-place Research Using Technology initiative (NIH grant U2C AG0543701; Veteran’s Administration grant IIR 17-144), the Oregon Roybal Center for Translational Research on Aging (NIA P30 AG024978), and the Oregon Clinical Translational Research Institute Clinical and Translational Science Award (NCATS UL1 TR002369). Some data were collected and managed using REDCap electronic data capture tools hosted at Oregon Health and Science University . The Collaborative Aging-in-place Research Using Technology initiative is funded by the Office of the Director, NIH, National Center for Advancing Translational Sciences, National Institute of Biomedical Imaging and Bioengineering, National Institute of Nursing Research, NIA, National Institute of Neurological Disorders and Stroke, National Cancer Institute, and the Veteran’s Administration.
©Adriana Seelye, Mira Isabelle Leese, Katherine Dorociak, Nicole Bouranis, Nora Mattek, Nicole Sharma, Zachary Beattie, Thomas Riley, Jonathan Lee, Kevin Cosgrove, Nicole Fleming, Jessica Klinger, John Ferguson, Greg John Lamberty, Jeffrey Kaye.
- Activities of daily living
- Mild cognitive impairment
PubMed: MeSH publication types
- Journal Article