Clinical Manifestations.

Background: Chronic depression impacts the ability to successfully manage one's health, yet mechanisms underlying this relationship are not fully understood. Cognitive dysfunction, or impairment, may result from persistent depression. We aimed to determine whether chronic depressive symptoms, leading to poor cognition, impacted self-management capacity among older adults with chronic conditions.

Clinical Manifestations.

Background: Most cognitive screening tests used in primary care to identify adults with cognitive impairment, including Alzheimer's disease and related dementias, have been limited in their diagnostic accuracy, especially in mild cases. Resultant false positives or false negatives (e.g.

An Initial Exploratory Examination of the Sensitivity and Specificity of MyCog Mobile Using the Mini-Cog as a Proxy for Suspected Cognitive Impairment.

Objectives: To help promote early detection of cognitive impairment in primary care, MyCog Mobile was designed as a cognitive screener that can be self-administered remotely on a personal smartphone. We explore the potential utility of MyCog Mobile in primary care by comparing MyCog Mobile to a commonly used screener, Mini-Cog.

Methods: A sample of 200 older adults 65+ years (mean age = 72.

Patient factors associated with telehealth quality and experience among adults with chronic conditions.

Objective: To evaluate patient-reported experiences of telehealth and disparities in access, use, and satisfaction with telehealth during the COVID-19 pandemic.

Materials And Methods: We examined data from the fifth wave of the COVID-19 & Chronic Conditions (C3) study conducted between December 2020 and March 2021.

Results: Of the 718 participants, 342 (47.

Protocol for a construct and clinical validation study of MyCog Mobile: a remote smartphone-based cognitive screener for older adults.

Introduction: Annual cognitive screening in older adults is essential for early detection of cognitive impairment, yet primary care settings face time constraints that present barriers to routine screening. A remote cognitive screener completed on a patient's personal smartphone before a visit has the potential to save primary care clinics time, encourage broader screening practices and increase early detection of cognitive decline. MyCog Mobile is a promising new remote smartphone-based cognitive screening app for primary care settings.

Prediction of cognitive impairment using higher order item response theory and machine learning models.

Timely detection of cognitive impairment (CI) is critical for the wellbeing of elderly individuals. The MyCog assessment employs two validated iPad-based measures from the NIH Toolbox for Assessment of Neurological and Behavioral Function (NIH Toolbox). These measures assess pivotal cognitive domains: Picture Sequence Memory (PSM) for episodic memory and Dimensional Change Card Sort Test (DCCS) for cognitive flexibility.

Remote Self-Administration of Cognitive Screeners for Older Adults Prior to a Primary Care Visit: Pilot Cross-Sectional Study of the Reliability and Usability of the MyCog Mobile Screening App.

Background: Routine cognitive screening is essential in the early detection of dementia, but time constraints in primary care settings often limit clinicians' ability to conduct screenings. MyCog Mobile is a newly developed cognitive screening system that patients can self-administer on their smartphones before a primary care visit, which can help save clinics' time, encourage broader screening practices, and increase early detection of cognitive decline.

Objective: The goal of this pilot study was to examine the feasibility, acceptability, and initial psychometric properties of MyCog Mobile.

Caregiver health literacy and health task performance: Findings from the LitCog caregiver cohort study.

Objective: Many older adults receive assistance in managing their chronic conditions. Yet complicating the utility of caregiver support is whether caregivers have sufficient skills to aid in older adults' health management at home. We examined associations between caregiver health literacy and performance on health tasks.

Cognitive function, self-management, and outcomes among liver transplant recipients: LivCog, a multicenter, prospective study.

Liver transplantation is a life-saving option for decompensated cirrhosis. Liver transplant recipients require advanced self-management skills, intact cognitive skills, and care partner support to improve long-term outcomes. Gaps remain in understanding post-liver transplant cognitive and health trajectories, and patient factors such as self-management skills, care partner support, and sleep.

Long-term impact of the COVID-19 pandemic on self-management of chronic conditions among high-risk adults in the USA: protocol for the C3 observational cohort study.

Introduction: COVID-19 is an unprecedented public health threat in modern times, especially for older adults or those with chronic illness. Beyond the threat of infection, the pandemic may also have longer-term impacts on mental and physical health. The COVID-19 & Chronic Conditions ('C3') study offers a unique opportunity to assess psychosocial and health/healthcare trajectories over 5 years among a diverse cohort of adults with comorbidities well-characterised from before the pandemic, at its onset, through multiple surges, vaccine rollouts and through the gradual easing of restrictions as society slowly returns to 'normal'.

LitCog Caregiver Cohort: a prospective, observational cohort study investigating US caregivers' health literacy, self-care skills and cognitive function.

Introduction: Many older adults receive assistance in managing chronic conditions. Yet complicating the utility of caregiver support is whether caregivers have sufficient skills to aid in a patient's self-care. Health literacy and cognition are important determinants of older adults' health outcomes, but few studies have examined caregiver health literacy, cognition and self-care skills and their relations to patient outcomes.

Patient randomised controlled trial of technology enabled strategies to promote treatment adherence in liver transplantation: rationale and design of the TEST trial.

Background And Aims: Liver transplantation is a life-saving procedure for end-stage liver disease. However, post-transplant medication regimens are complex and non-adherence is common. Post-transplant medication non-adherence is associated with graft rejection, which can have long-term adverse consequences.

Pilot Testing of the MyCog Assessment: Rapid Detection of Cognitive Impairment in Everyday Clinical Settings.

Cognitive impairment (CI) and dementia can have profound social and emotional effects on older adults. Early detection of CI is imperative both to the identification of potentially treatable conditions and to provide services to minimize the effects of CI in cases of dementia. While primary care settings are ideal for identifying CI, it frequently goes undetected.

Impact of COVID-19 on the capacity to self-manage health and chronic conditions.

Objective: To investigate well-being, lifestyle behaviors, self-management capacity and healthcare utilization among adults with chronic conditions at the outbreak of the COVID-19 pandemic.

Methods: Data was collected from two interviewer-administered telephone surveys conducted between March 27 - May 22, 2020. Participants were patients at Chicago-area clinics.

Early COVID-19 Attitudes and Behaviors and Their Associations With Later Infection: A Local Perspective From One U.S. City.

Background: At the onset of the pandemic, there was poor public awareness and inaction in response to COVID-19; it is less known whether this translated to subsequent infections.

Objectives: To explore whether adults who perceived COVID-19 as less of a threat and who were not taking early actions were more likely to become infected over the following year.

Research Design: Survey data from the ongoing (COVID-19 & Chronic Conditions (C3) anonymized for review) cohort study.

Associations Between Cognitive Impairment Severity and Barriers to Healthcare Engagement Among Older Adults.

To assess whether older adults with a cognitive impairment were more likely to report challenges interacting with medical providers, or to avoid needed medical care. Data for this exploratory, cross-sectional analysis were from older adults ( = 493) ages 60-82 participating in the "LitCog" cohort study. Multivariable generalized linear models compared cognitive impairment (none, mild, moderate, severe) with validated measures of healthcare engagement.

Remote Cognitive Screening Of Healthy Older Adults for Primary Care With the MyCog Mobile App: Iterative Design and Usability Evaluation.

Background: Annual cognitive screening in adults aged >65 years can improve early detection of cognitive impairment, yet less than half of all cases are identified in primary care. Time constraints in primary care settings present a major barrier to routine screening. A remote cognitive screener completed on a patient's own smartphone before a visit has the potential to save primary care clinics time, encourage broader screening practices, and increase early detection of cognitive decline.

Persistent loneliness due to COVID-19 over 18 months of the pandemic: A prospective cohort study.

Background: Loneliness was common early in the COVID-19 pandemic due to physical distancing measures, but little is known about how loneliness persisted into later stages of the pandemic. We therefore examined longitudinal trajectories of loneliness over 18 months of the pandemic and subgroups at risk for persistent loneliness.

Methods: We used data from the COVID-19 & Chronic Conditions study collected between March 27, 2020 to December 10, 2021, including 641 predominantly older adults with ≥1 chronic condition who completed six interviews at approximately 3 month intervals.

The Roles of Busyness and Daily Routine in Medication Management Behaviors Among Older Adults.

Busyness (the density of activities) and daily routine (patterns of organizing time) are two understudied factors that likely impact medication-taking behaviors. We examined the association between busyness and routine with medication adherence (MA) in 405 older adults with adequate cognition using multivariable models. The final model included an interaction term between daily routine and busyness.

Trajectories of perceived susceptibility to COVID-19 over a year: The COVID-19 & chronic conditions (C3) cohort study.

The U.S. public health response to coronavirus disease 2019 (COVID-19) has been widely criticized as having downplayed the potential implications COVID-19 could have on one's personal health.

Factors associated with COVID-19 vaccine trust and hesitancy among adults with chronic conditions.

In a survey of older adults at higher risk for COVID-19 complications, we sought to describe expectations of trust in the safety and efficacy of a future COVID-19 vaccine, and level of hesitancy about receiving it. We also assessed whether these expectations were associated with known or suspected contributors to vaccine hesitancy, disparities in vaccine receipt, and potential targets for public health outreach. From May 1-22, 2020, we performed telephone surveys of 601 older adults with chronic conditions in metro Chicago about their COVID-19 experiences and levels of vaccine trust and hesitancy.

Caregiver involvement in managing medications among older adults with multiple chronic conditions.

Objective: We sought to characterize caregiver medication assistance for older adults with multiple chronic conditions.

Design: Semi-structured qualitative interviews.

Setting: Community and academic-affiliated primary care practices.

Perceived Adequacy of Tangible Support during Stay-at-Home Orders in Chicago and New York.

Objectives: Physical distancing precautions during the COVID-19 pandemic may challenge the provision of tangible support many middle age and older adults receive in managing their health. We examined the association between unmet tangible support needs and self-management behaviors and mental health status during the stay-at-home orders in Chicago and New York.

Methods: We used data from the COVID-19 & Chronic Conditions study collected between May 1st and May 22nd, 2020.

Rationale and study design for decision making & implementation of aging-in-place/long term care plans among older adults.

Background: Remaining in one's own home and community is a priority for many older adults as they age. Decision-making and planning is critical to ensure successful aging-in-place (AIP), especially when individuals experience age-related changes such as cognitive decline. : We are testing how decision-making and planning for AIP is impacted by changes in older adults' cognition and function, chronic conditions, social influences, environmental factors and identifying the mediating/moderating interactions between factors.