Promoting Exercise to Mitigate Hospital-Associated Disability for People with Dementia - A Feasibility Pilot
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ABSTRACT Candidate: I am a fellowship-trained Geriatrician and physician-investigator at the University of North Carolina (UNC). As an Assistant Professor of Medicine, I have developed expertise in quality improvement, observational research, and secondary analysis of clinical trials. My long-term goal is to establish an independently funded research program that develops, tests, and implements scalable interventions to prevent hospital-associated disability in older adults, including people with dementia (PwD). For this K23 application, I propose training in 1) adapting interventions for PwD, 2) clinical trial methodology, and 3) implementation science. Environment and Mentorship: As a premier research institution, UNC is an ideal setting for the proposed research. The Division of Geriatric Medicine and surrounding Health Affairs Campus is home to accomplished clinical scientists leading research to improve care for older adults and PwD. I have established collaboration with my primary co-mentors Drs Hanson and Batsis and have support from mentors and advisors with expertise in clinical trials, exercise for older adults, and implementation science. They have committed to guide this research and support my career development. Furthermore, UNC has demonstrated strong institutional support for my career by providing the salary support necessary for developing this proposal. Research: In the U.S., Alzheimer’s Disease and Related Dementias (ADRD) affects an estimated 6.9 million people, a population projected to double by 2060. Approximately 32% of PwD are hospitalized each year, and they are seven times more likely than individuals without dementia to acquire a hospital-associated disability, resulting in a loss of independence in at least one activity of daily living. Hospital-associated disability reduces quality of life, increases caregiver strain, and heightens the risk of nursing home placement and premature death. The overarching goal of proposed research is to develop and pilot test ACTIVE-AD—ACTIVity and Exercise for hospitalized people with ADRD to address the gap in effective, scalable, and sustainable strategies to tailor hospital care for PwD. Following the NIH stage model, our specific aims are to: 1) adapt an existing hospital- based exercise program for PwD, 2) assess ACTIVE-AD’s feasibility in 30 PwD-caregiver dyads, and 3) identify and address implementation determinants. The project's scientific and training aims will establish ACTIVE-AD’s feasibility and equip me with the expertise to lead an R01-funded efficacy trial (NIH Stage Model 2). This work aligns with the National Institute on Aging's objectives and the National Plan to Address Alzheimer's Disease's advocacy for nonpharmacologic trials to slow cognitive and physical function decline in PwD.
