UCLA CTSI and University of Minnesota Cross-Institutional Award Projects Principal Investigators: Joshua Chodosh (UCLA) and Joseph Gaugler (University of Minnesota) In the next decade Latinos will make up the largest racial/ethnic minority group among U.S. adults 65 years and older. However, Latino older adults face a number of challenges, including increased burden of chronic illness and limited access to health care. This extends to Alzheimer’s disease or related disorders; the prevalence of dementia among Latinos is potentially higher than in other racial/ethnic groups as symptom onset has been shown to occur six to seven years earlier in Latinos than in non-Latinos. The objective of this cross-institutional project is to ascertain the feasibility, acceptability, and utility of the Alzheimer’s Disease Coordinated Care for Hispanic and Latino seniors intervention (ADC-HL), a community-centered, dementia care management protocol designed to reduce caregiver burden as well as dementia-related symptoms (e.g., behavioral disturbances) in 15 persons with memory loss for Hispanic/Latino families in St. Paul, Minnesota. Innovative components of this project include a focus on dementia care in an underserved community, the use of mixed methods to collect and analyze a range of qualitative and quantitative process data, and reliance on an evidence-informed approach to build and refine a coordinated care management protocol for Hispanics/Latinos with dementia and their families.

1. 1
Alzheimer’s Disease Coordinated Care for
Hispanic and Latino Seniors: Pilot
Implementation
JOSEPH E. GAUGLER, PH.D.
ASSOCIATE PROFESSOR
MCKNIGHT PRESIDENTIAL FELLOW
SCHOOL OF NURSING
UNIVERSITY OF MINNESOTA
JOSHUA CHODOSH, MD, MSHS
ASSOCIATE PROFESSOR OF MEDICINE
DAVID GEFFEN SCHOOL OF MEDICINE AT UCLA
VA GREATER LOS ANGELES HEALTH SYSTEM, GRECC
ASSISTANT CHIEF OF STAFF/PATIENT SAFETY

2. ACKNOWLEDGEMENTS
• The UCLA and University of Minnesota Clinical and
Transla8onal Science Ins8tutes
• Ana Diaz, MD, of Payne Phalen Block Nurse Program,
St. Paul, MN

3. OVERVIEW
• Demen8a prevalence is high among US La8no popula8ons
and onset is oLen at earlier age
• Problems are magnified by poverty and poor access to
healthcare services
• ADC‐HL is a transla8on of the Alzheimer’s disease
Coordinated Care for San Diego Seniors (ACCESS) study
(Vickrey, PI)
• The ADC‐HL is a community‐centered, demen8a care
management protocol designed to reduce caregiver burden
and challenging, demen8a‐related symptoms (e.g.,
behavioral disturbances) in La8no/Hispanic families.

4. OBJECTIVE
• To ascertain the feasibility of the Alzheimer’s Disease
Coordinated Care for Hispanic and La8no Seniors interven8on
(ADC‐HL) in St. Paul, MN.
• To develop a care management program with the best
opportunity to achieve the greatest relevance and
effec8veness for this popula8on
• To reduce caregiver burden and challenging, demen8a‐related
symptoms (e.g., behavioral disturbances) in La8no/Hispanic
families.
• To develop strong collabora8ve processes between UM and
UCLA for future transla8onal research in demen8a within
La8no/Hispanic communi8es

5. SPECIFIC AIMS
• Complete a feasibility study of the ADC‐HL with 17 Hispanic or
La8no demen8a caregivers that collects informa8on on fidelity
of ADC‐HL implementa8on, ADC‐HL uptake by family
caregivers, and ADC‐HL impact on everyday caregiver ac8ons/
behaviors.
• Measure changes in key outcomes that ADC‐HL is designed to
improve, including reducing the severity of demen8a symptoms
for persons with Memory loss (PWMLs), health service use for
PWMLs, and self‐reported family caregiver stress, mood, and
quality of family care processes over a 4‐month period.

6. SIGNIFICANCE
• Over 5 million individuals in the U.S. have Alzheimer’s disease
and related demen8as
• Significant burden across families.
• Prevalence among Hispanic/La8nos is poten8ally higher than
in other racial/ethnic groups with symptom onset occurring
6‐7 years earlier than in non‐Hispanic/La8nos.
• Hispanic/La8no popula8on > 65 yrs will be the largest racial/
ethnic minority among older adults in the U.S. by 2019
• 19.8% of U.S. older adults by 2050.
• Lack of accultura8on and socioeconomic barriers =
exacerbated demen8a care in Hispanic/La8no communi8es.

7. PREVIOUS & PRELIMINARY STUDIES: ACCESS
Vickrey, et al. Ann Intern Med. 2006;145 713‐26

8. PREVIOUS & PRELIMINARY STUDIES: ACCESS
PATIENT AND CAREGIVER HEALTH
8
Usual Care
Mean
Interven8on
Mean
Adjusted
Between‐
Group
Difference
P ‐Value
Pa8ent’s health related quality of
life (0‐1 range)
0.03 0.10 0.06 0.03
Overall quality of healthcare (0‐10
range)
7.9 8.2 0.5 0.003
Caregiver Confidence in Caregiving
(0‐100 range)
60 67 6.4 0.001
Caregiving‐anributable Health
Strain (0‐100 range)
60 64 4.3 0.06
* Higher scores mean bener outcomes Vickrey, et al. Annals 2006;145:713‐726.

9. PREVIOUS & PRELIMINARY STUDIES: ACCESS
Teams Produce Bener Quality
DCM= Demen8a Care Manager; Community= All 3 components together
Chodosh, et al. Am J Man Care 2012;18:85‐94.

10. PREVIOUS & PRELIMINARY STUDIES: V‐CAMP
Ac#ons Taken % Referrals Requested%
Comprehensive assessment 100% 62.7%
Blood pressure management 32.8% 0%
Hearing assessment/interven8on 26.9% 0%
New demen8a diagnosis 26.9% 62.7%
Exercise rou8ne provided 26.9% 0%
Physical therapy ordered 23.9% 0%
Advance care planning 23.9% 0%
Driving recommenda8ons 22.4% 0%
An8cholinergic/Benzo reduc8on 22.4% 0%
Incon8nence assessment / therapy 19.4% 0%
ID bracelet provided 17.9% 0%
Sleep management 16.4% 0%
ACh‐I Discon8nued 16.4% 0% 10

11. PREVIOUS & PRELIMINARY STUDIES:
Compara8ve Effec8veness of Demen8a Care Strategies in
Underserved Communi8es
• Care management comparing community‐based (in person) versus
telephone‐only care
• San Fernando Valley – Predominantly La8no immigrant
underserved community
• Preliminary findings:
 Large service needs
 Vast educa8onal gaps
 Socioeconomic pressures
 Immigra8on challenges
 Percep8on of need differs between caregiver and care manager
 Enrollment challenges
 Even larger follow‐up challenges

12. ADDITIONAL POINTS OF INNOVATION
• A focus on demen8a care in an underserved community
• Use of mixed methods design
• Applica8on of new assessment tools for greater efficiency but
needing feedback from caregivers / care managers
• Restructuring of care management process to achieve greater
clarity for caregivers immersed in the process, care managers
learning the process, and for educa8ng others

13. APPROACH
• Phase I. Training. Videoconference training of Dr. Diaz
over a 2 month period
• Phase II. Feasibility study. Enroll 17 family caregivers of
persons with memory loss from PPBN in east St. Paul, MN
1. Baseline assessment (RAM, HABC-Monitor, service use, use of
anti-dementia drugs, sociodemographics)
2. Implementation of ADC-HL protocol.
3. 4-Month assessment (RAM, HABC-Monitor, service use, use of
anti-dementia drugs)
4. Post-ADC-HL focus group to examine ADC-HL uptake and
impact as perceived by family caregiver participants.

14. ANALYSIS
• Feasibility analysis: Specific Aim 1.
 Univariate, descriptive statistics will be conducted to examine
empirical process data (e.g., duration and frequency of ADC-HL
care coordination use) to examine the feasibility of the ADC-HL.
 In addition, thematic content analysis of focus group data will take
place to determine barriers to ADC-HL use as well as why the
ADC-HL does or does not work for participants

15. ANALYSIS
• Descriptive longitudinal analysis: Specific Aim 2.
 Cronbach's alpha (α) estimates will examine reliability of all
summed measures.
 Each outcome variable will be examined to determine if skewness
exists or outliers are present. Normal probability plots and
histograms of each dependent variable will be analyzed.
 Data available at baseline and 4 months will also allow for
longitudinal analyses of rate of change in key outcomes: i.e., the
various domains assessed by the RAM and HABC-Monitor, health
service use, and acetylcholinesterase inhibitor use.
 A classic repeated measures analysis of variance will be
conducted using SPSS.
 Additional analyses will determine if covariates (e.g.,
sociodemographics) are correlated with change in ADC-HL
outcomes during the 4-month study period.

16. FUTURE PLANS
• Preliminary results will support translational research proposal in
response to PA-11-123: Translational Research to Help Older Adults
Maintain their Health and Independence in the Community R01.
• Feasibility data from this project along with Los Angeles-based
comparative effectiveness evaluation will provide strong preliminary
data for a multi-site translational project of ADC-HL.
• We will leverage several existing University of Minnesota/UCLA
CTSI resources.
 Delaware Clinical Research Unit
 Communuity Engagement for Health at the University of
Minnesota and UCLA’s sister office
 The CTSI Biostatistical Design and Analysis Center will be
utilized for the subsequent R01 proposal

17. QUESTIONS?
Joseph E. Gaugler, Ph.D.
Phone: 612‐626‐2485
Email: gaug0015@umn.edu
Joshua Chodosh, MD, MSHS
Phone: 310‐268‐3361
Email: JChodosh@mednet.ucla.edu