ASU's Roybal Center aims to give older adults experiencing cognitive decline more independence
David Coon, associate dean, professor and director of ASU’s Center for Innovation in Healthy and Resilient Aging, speaks during the launch of the Roybal Center at the Downtown Phoenix campus on March 18. Photo by Emma Fitzgerald/Arizona State University
For older people living alone and suffering from cognitive decline, life can be an unsettling and sometimes scary experience.
Arizona State University is out to improve that experience.
Two projects have begun within ASU’s Roybal Center, which was created last summer when the Edson College of Nursing and Health Innovation received a $5.8 million grant from the National Institute on Aging, part of the National Institutes of Health.
Only about 15 U.S. universities and institutes are awarded a Roybal Center.
“This is a huge honor,” said Fang Yu, the Edson College Chair in Dementia Translational Nursing Science, a professor at the college and the principal investigator and center director of ASU Roybal.
The Roybal Center will build research infrastructure and advance clinical trials to develop and adapt technology-enabled lifestyle and behavioral interventions. The end goal is providing practical solutions to older adults in order to help them maintain their independence while managing the challenges of cognitive change.
David Coon, associate dean, professor and director of ASU’s Center for Innovation in Healthy and Resilient Aging, or CIHRA, said the need for Roybal’s services is greater than ever. During a launch event Tuesday at ASU’s Health North building in downtown Phoenix, he said that the fastest growing age group in the United States is people 80 and over, and by 2030, there will be more people over the age of 65 than under 18.
In addition, Yu said there is a national shortage of geriatric providers, a “crisis” that will become even more acute in the coming years because while the percentage of Americans living with dementia has decreased from 13% in 2011 to 10.9% percent today, the number of people is actually increasing because of the aging population.
“And many of them want to continue to live alone,” Yu said. “So designing services for them is important. We want to enable them.”
The two projects underway at the Roybal Center are led by principal investigators Molly Maxfield, an associate professor in the Edson College and a fellow in in CIHRA, and Abigail Gomez-Morales, an assistant professor within Edson College.
Maxfield’s project is called I-PASS, which stands for Increasing Physical Activity Through Social Support and Stress Resilience. The project focuses on people 60 years and older who are living alone, experiencing the sense that their cognitive ability is changing or has become impaired, and are physically less active.
“We know one of the most powerful things in terms of reducing our dementia risk and maintaining independence is staying physically active,” Maxfield said. “So we will be using some goal-setting techniques to help people increase their physical activity and do that with increased social support, knowing that social isolation and chronic uncontrolled stress are two other risk factors for dementia.”
Maxwell said her team is using social media and flyers at various clinics to identify 90 people who want to participate in the project, which is scheduled to launch within the next month.
Each participant will receive an initial baseline assessment to determine their overall cognitive function, emotional function and social connectedness. They will then begin a three-month intervention in which they’ll be supplied with a Garmin tracker that will monitor their physical activity — with a goal of reaching 150 minutes of moderate to vigorous activity per week — a study manual providing basic education about physical activity guidelines and the importance of social engagement, and weekly text messages with physical activity goals.
Participants comfortable with technology will have access and guided use to an app designed to foster social engagement, stress management and physical activity.
Each participant also will receive six individualized coaching sessions delivered via Zoom.
“We have a lot of strategies on how to become more physically active in a safe way. Things like maintaining balance and creating a safe environment for activity," Maxfield said, adding that participants with physical health issues would need to receive a clearance form from their physician. "Engaging in group exercise is a way to not only become more active, but to connect with others. We’ll do ... weekly check-ins to foster some of the connectedness and identification with the study in the hopes that it provides additional motivation.”
Gomez-Morales’ project, called Epic LA+, stands for Early Partners in Care Living Alone. While I-PASS focuses on physical activity, the emphasis of Epic LA+ is to help older people experiencing cognitive decline plan as best they can for the rest of their lives.
“We all know that, unfortunately, you’re going to decline,” Gomez-Morales said. “So what we are giving you is how can you better communicate your limitations with others? How can you prepare for the needs that you’re going to have?”
The 70 participants in the project will be in the “earlier stages” of cognitive decline, Gomez-Morales said, “because that’s the best moment to start planning for the future. Your ability to make decisions is not impaired yet.”
The participants will take part in a seven-week program aimed at skill building and care planning. Six of the seven sessions will be group sessions, and the seventh will be an individualized session.
The goal of the sessions, Gomez-Morales said, is to discuss how the participants can manage their everyday life, what their life will look like going forward and to make decisions that will need to eventually be settled
If the participants don’t have a care partner identified, Gomez-Morales’ team will try to help them identify one.
“We’ll talk about basic needs, like doing the dishes, cooking and going to appointments. It can be something like managing finances," Gomez-Morales said. “The vast majority of them are still doing those things by themselves, but down the line, they are going to need a care partner. So now is a perfect moment to start that conversation.”
Gomez-Morales said the individual sessions will focus in part on the “care values” of the participants.
“How do they want to divide the tasks that they need help with?” she said. “Do they want to have a friend doing laundry or do they want to pay someone to do it? The participant can take more or less responsibility, depending on their own personal needs.”
Gomez-Morales said her hope is that the participants in the project “receive the confidence that they need to live their best every day and keep living in their community.”
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