Dementia is the most expensive medical condition in the US and is a risk factor for nursing home admission. More than a million older adults reside in nursing homes in the US. This number will increase as our older adult population rapidly expands. Thus, innovative approaches to reducing dementia incidence, subsequent nursing home admissions, and associated costs are urgently needed. Increasing evidence indicates that sensory/per- ceptual and motor declines are early markers of dementia, and may be ideal therapeutic targets. Along these lines, recent analyses demonstrate that older adults randomized to perceptual/cognitive training (i.e., useful field of view training- UFOVT) are up to 48% less likely to develop dementia. Across 18 randomized clinical trials UFOVT demonstrates numerous benefits including improved motor, cognitive, and everyday function, prolonged health and well-being, and reduced projected healthcare expenditures. Thus, it is likely that UFOVT has clinically-meaningful public health benefits. However, no study has quantified the effects of UFOVT on the clinical diagnosis of dementia, rates of nursing home admission, or actual healthcare cost. Our overall objectives are to 1) elucidate the longitudinal contributions of sensory/perceptual, cognitive, and motor function to dementia and related outcomes; and 2) quantify the longitudinal effects of UFOVT on dementia diagnosis, nursing home admission rates, and associated cost. Our central hypothesis is that sensory/perceptual and motor difficulties precede the cognitive and functional impairments that are the hallmarks of dementia. Thus, targeting early perceptual processing may be an ideal approach to reduce dementia risk. Data from a large sample of older adults enrolled in two randomized trials of UFOVT (i.e., SKILL and Accelerate studies) will be linked to data from the Center for Medicare and Medicaid Services (CMS). These two NIH-funded studies included 1475 community-dwelling older adults who completed thorough sensory/perceptual, motor, and cognitive assessments. Participants were randomized to UFOVT or an active control condition and followed over three years. The proposed project will add objective health outcomes to the existing cohort data including diagnosis of dementia, nursing home admissions, permanent nursing home placements, and healthcare utilization and cost outcomes spanning 10 years. The resulting data will equip us to examine novel predictors of dementia and evaluate the sustainability of UFOVT effects on clinically meaningful health outcomes. Findings from this study will have important long term implications for designing interventions and implementing policies to extend the independence of older adults for the benefit of public health. Results will inform the design of future epidemiologic and intervention studies. The resulting database will enable contin- ued investigation of innovative hypotheses in clinical aging research, thereby exerting a sustained influence in the field. The proposed project is thus an efficient approach to meet the objectives of PA-17-089 exploratory analyses of existing cohorts to address clinical aging research questions.
The proposed research is relevant to public heath because the prevalence of dementia is increasing rapidly and is the most expensive medical condition. The proposed research will determine the efficacy of perceptual/cognitive training to reduce incidence of dementia, nursing home admissions, and healthcare cost. Thus, the proposed research is relevant to NIH's mission to enhance health, lengthen life, and reduce illness and disability.