HealthStreet Cognitive Screening Project

Description

Alzheimer's Disease (AD) is one of several neurodegenerative conditions that impact an individual's memory. According to an Alzheimer's Association report, in 2020, AD was impacting over half-a-million Floridians, a number second highest in the nation with California having the most. In view of these numbers, experts report several benefits linked to early identification of AD and other dementia types: personal and family emotional support needs, social, medical intervention and treatment benefits, costs savings, and increased time to plan for the conditions' future impacts.

With a 2017 grant from the Florida Department of Health's Ed and Ethel Moore Alzheimer's Disease Research Grant, the Department of Epidemiology at the University of Florida (UF) designed a research project that focused on collecting information from the state's rural population age 60 and older — a group proven by research to have not only a higher prevalence and death rate due to AD, but a group also less likely to be diagnosed, receive treatment, and be included in medical research. Although one urban county was included, outreach was specific to eight rural Florida counties chosen on the basis of their high AD mortality rates, four counties rural by CMS definition (Marion, Bay, Gulf, and Wakulla) and four designated as rural by the Federal Office of Rural Health Policy's definition (Putnam, Washington, Calhoun, and Jackson).

The grant leveraged UF's translational science infrastructure for community engagement. Grant goals included data collection, providing participants with local referral information when mortality-related health issues were identified and, for rural Florida healthcare providers, creating free easily-accessed educational offerings on the topic of cognitive impairment and dementia.

Participant data collection was done by the department's community engagement program called HealthStreet. Six certified HealthStreet Community Health Workers (CHWs) provided outreach at events like health fairs or in locations like community centers, public libraries, clinic settings, churches — even laundromats and bus stops in larger areas.

After obtaining informed consent, the CHWs collected sociodemographic information, reviewed medical and substance use history, and also assessed willingness to participate in future research efforts. Grant-specific data intake forms were used for the generalized health-related questions, an AD questionnaire, and the Montreal Cognitive Assessment (MoCA), a one-page screening tool with high sensitivity addressing items specific to memory.

Although MoCA results were not shared with participants, when assessments indicated the need, CHWs provided general education to the participant and their caregiver or family if present. Paper copies of information were provided at the time of the interaction.

CHW-participant conversations also included information on local social and medical services, including information for those participants without a medical home. At 2-months and 4-months after the original interaction, CHWs made follow-up calls to participants in order to address any interval questions and to follow-up on continued willingness to participate in future research. Contact information of community participants with continued interest in research activities was forwarded to research navigators who then connected with the appropriate university coordinator to further evaluate research study eligibility.

Regarding the second grant to engage the target county primary care clinicians, email listservs and providers' professional organizations were used to invite these clinicians to participate in a free, online, continuing medical education (CME) module, From Brain Disorders to Brain Health: Prevention and Management of Cognitive Decline and Dementia. The module included overall review of cognitive conditions, current screening and diagnostic tools, treatments, and available resources for the practitioners themselves and their patients — including specific information on referring patients to the Florida's designated memory clinics. Data collection for this grant included pre- and post-activity surveys and geographic location of provider participant.

Services offered

In addition to the continuing medical education information for clinical providers, key to the grant work were the HealthStreet CHWs, the grant-specific information forms, including cognitive screening tools. Also helpful were the community-specific resource guides created by the research team for each target county.

Results

As of December 2020, the CHW model of engagement with older adults had resulted in the enrollment nearly 600 older adults along with about 1,300 referrals to local community resources.

Challenges

• Recruitment of qualified applicants to serve as CHWs in rural Florida.
• Navigation of the circuitous pathway from CHW assessment to the eventual required physician-only referral to Florida's dementia care infrastructure
• For those participants with the referrals, transportation and other similar challenges to making an urban-located appointment

Replication

• Identification of geographic areas in most need of health assessments and cognitive screening
• Identification of collaborators with expertise in cognitive health to develop and create an educational intervention for clinicians
• Recruitment process and training protocol for CHWs
• Creation of forms for informed consent, health screening, and cognitive screening
• Identification and training of staff to create reports and complete data analyses

Contact Information