Meghan Mattos

• PhD, RN, CNL
• Professor (Associate) at University of Virginia

Background/Objectives Frailty assessments in older adults are an important prognostic indicator for predicting health-related outcomes. The purpose of this study was to determine the feasibility and acceptability of using a wrist-worn actigraphy device to measure frailty in homebound older adults. Methods In this US single-site cohort study, older...

Background Prior research on factors associated with sleep problems among care partners (CPs) of persons with cognitive decline (PwCD) are often limited by imprecise (i.e., single yes/no questions) measures of insomnia, burden, and CP mental health. This study aimed to: 1) determine the prevalence of insomnia disorder using DSM‐5 criteria among PwC...

The increased use of PET amyloid imaging in clinical research has sparked numerous concerns about whether and how to return such research test results to study participants. Chief among these is the question of how best to disclose amyloid imaging research results to individuals who have cognitive symptoms that could impede comprehension of the inf...

Objective To perform the first mixed‐methods analysis of patient expectations and satisfaction after endoscopic sinus surgery (ESS). Methods Semi‐structured interviews of subjects undergoing ESS were performed to understand pre‐operative expectations and 6‐month post‐operative satisfaction. Descriptive statistics, logistic regression, and mediatio...

Background and objectives: Seizures are common in dementia and associated with accelerated cognitive decline. However, the impact of active vs remote seizures on cognition remains understudied. This study aimed to investigate the impact of active vs remote seizures on cognition in people with normal cognition and mild cognitive impairment (MCI)....

Background Morning blood pressure surge (MBPS) has been recognized as an independent predictor of cardiovascular disease events. Psychological distress, including anxiety, depression, and perceived stress, and behavioral risk factors, such as poor sleep quality, have been associated with increased MBPS. Elevations in sympathetic activity induced by...

Background Digital health interventions show potential to increase caregivers’ access to psychosocial care; however, it is unclear to what extent existing interventions may need to be tailored to meet caregivers’ unique needs. Purpose This study aimed to determine whether—and if so, how—an efficacious Internet-delivered insomnia program should be...

Background Delivering insomnia treatment by the Internet holds promise for increasing care access to family caregivers, but their ability to adhere to and benefit from such fully-automated programs has not been rigorously tested. Purpose This fully-powered, single-group trial tested whether characteristics of the caregiving context influence high-...

Background: Older adults with insomnia face considerable challenges accessing treatment given limited availability to first-line therapy (cognitive-behavioral therapy for insomnia, CBT-I) and risks related to second-line treatment (pharmacotherapy).Objectives: Evaluate the efficacy of Sleep Healthy Using the Internet for Older Adults Suffering with...

Sleep disturbances may promote the development and advancement of Alzheimer’s disease. Our purpose was to determine if sleep disturbances were associated with earlier mortality while accounting for cognition. The National Alzheimer’s Coordinating Center database was used to evaluate mortality risk conferred by sleep, and the Montreal Cognitive Asse...

Background and Objectives Caregivers of persons with dementia report worse sleep when compared to the general population. The objective of this review was to synthesize evidence regarding the link between caregiver burden and dementia caregivers’ sleep. Research Design and Methods We conducted a scoping review using a systematic search for pertine...

Background Sleep disturbances, including insomnia, poor sleep quality, and sleep fragmentation, are implicated in the development and progression of Alzheimer’s disease and related dementias in older adults. However, the effect of sleep disturbances on lifespan in those with cognitive impairment has not been studied independently from other neurops...

Background Caregivers of persons with cognitive decline (PWCD) are at increased risk of poor sleep quantity and quality. It is unclear whether this is due to factors in the caregiver versus in the PWCD. Methods This secondary data analysis using Aging, Demographics, and Memory Study data from the Health Retirement Study examined factors contributi...

Background: Delivering insomnia treatment by the Internet holds promise for increasing care access to family caregivers, but their ability to adhere to and benefit from such fully-automated programs has not been rigorously tested. Purpose: This fully-powered, single-group trial tested whether characteristics of the caregiving context influence high...

Objective: Digital health interventions show potential to increase caregivers’ access to psychosocial care; however, it is unclear to what extent existing interventions may need to be tailored to meet caregivers’ unique needs. This study aimed to determine whether – and if so, how – an efficacious Internet-delivered insomnia program should be modif...

Introduction: Biomarker testing for Alzheimer's disease and related disorders (ADRD) brings new opportunities for nurses to foster shared decision-making by leading pre-test counseling (PTC) for patients and families. Methods: Audio-recordings of 18 nurse-led PTC sessions were analyzed to characterize questions posed by patient and family member...

Background The effect of nighttime behaviors on cognition has not been studied independently from other neuropsychiatric symptoms. Objective We evaluate the following hypotheses that sleep disturbances bring increased risk of earlier cognitive impairment, and more importantly that the effect of sleep disturbances is independent from other neuropsy...

Evidence supports that older adults with cognitive impairment can reliably communicate their values and choices, even as cognition may decline. Shared decision-making, including the patient, family members, and healthcare providers, is critical to patient-centered care. The aim of this scoping review was to synthesize what is known about shared dec...

Objectives: The purpose of this study was to investigate insomnia symptoms and excessive sleep/sluggishness across stages of cognitive decline (cognitively normal [CN], Cognitively Impairment, Not Demented [CIND], dementia) in a large, racially/ethnically diverse sample of older adults (70+) in the US. We also examined whether sleep disturbances a...

Homebound persons living with dementia (PWD) require healthcare services that proliferate with physical and cognitive changes over time. PWD often experience fragmented care that results in poor health outcomes and delayed healthcare access. The objective of the Virginia at Home Program (VaH), a recently initiated home-based primary care (HBPC) pro...

Caregivers of persons with dementia report worse sleep when compared to the general population. This scoping review synthesizes evidence regarding the link between caregiver burden and dementia caregivers’ sleep. A systematic search was completed in PubMed, CINAHL, PsycINFO, and Web of Science for pertinent literature published through March 2022....

Evidence supports that older adults with cognitive impairment can reliably communicate their values and choices, even as cognition declines. Shared decision‐making (SDM), including the patient, family members, and healthcare providers, is critical to patient‐centered care. The aim of this scoping review was to synthesize what is known about SDM in...

While sleep disturbances appear to be risk factors in the progression of Alzheimer’s disease (AD) and other dementias, little is known about the prevalence across dementia severity and the potential influence on the trajectory of cognitive decline. We used the prospective National Alzheimer Coordinating Center Uniform Data Set to evaluate the hypot...

Older adults rapidly adopted technology for healthcare, known as digital health, during the COVID-19 pandemic. Older adults are increasingly using telehealth, smartphone apps, and other digital health technologies to reduce barriers to care, maintain patient-provider communication, and promote disease self-management. Yet, many healthcare professio...

Background While sleep disturbances appear to be risk factors in Alzheimer’s disease (AD) progression, information such as the prevalence across dementia severity and the influence on the trajectory of cognitive decline is unclear. Objective We evaluate the hypotheses that the prevalence of insomnia differs by cognitive impairment, that sleep dist...

Objective To test whether an Internet-delivered cognitive behavioral therapy for insomnia (CBT-I) program for older adults attenuates symptoms of depression and anxiety. Methods Adults aged ≥ 55 with insomnia were randomized to SHUTi-OASIS (Sleep Healthy Using the Internet for Older Adult Sufferers of Insomnia and Sleeplessness; N = 207) or Patien...

Over ninety percent of people with dementia (PWD) experience behavioral and psychological symptoms, known to increase burden on care providers and healthcare systems. The purpose of this integrative review was to examine the modifiable risk factors of behavioral and psychological symptoms of dementia (BPSD) at the individual, caregiver, and environ...

Clinical research involving participants with mild cognitive impairment (MCI) presents challenges to recruitment that may be further compounded by concerns when delivering a behavioral intervention via the Internet. The purpose of this talk is to describe recruitment adaptations for an Internet-delivered behavioral intervention study with older adu...

Recruiting and enrolling older adults with cognitive impairment is challenging under the best of circumstances. This symposium will begin with an introduction to best practices for recruitment of older adults living with cognitive impairment, followed by four presentations describing recruitment successes and challenges across multiple settings. Th...

The COVID pandemic has impacted access to care, particularly for older, homebound persons living with dementia (PwD). At the beginning of the pandemic, our interdisciplinary team introduced a home-based medical care program (HBMC) to address chronically ill and homebound PwD and caregivers’ needs to promote aging in place. The purpose of this prese...

Background: Insomnia is present in up to 50% of older adults with cognitive impairment. When insomnia is left untreated, pre-existing cognitive problems may be exacerbated and potentially contribute to further cognitive decline. One promising approach to improve cognitive health in individuals with cognitive impairment is to improve quantity and q...

BACKGROUND Family caregivers are more likely to experience insomnia relative to non-caregivers, but have significant barriers to accessing gold-standard Cognitive Behavioral Therapy for Insomnia (CBT-I) treatment. Delivering interventions for caregivers by the Internet may help increase access to care, particularly among higher-intensity caregivers...

Background: Family caregivers are more likely to experience insomnia relative to noncaregivers but have significant barriers to accessing gold standard cognitive behavioral therapy for insomnia treatment. Delivering interventions to caregivers through the internet may help increase access to care, particularly among higher-intensity caregivers who...

Background Approximately 50% of older adults with cognitive impairment suffer from insomnia. When untreated, pre-existing cognitive problems may be exacerbated and potentially contribute to further cognitive decline. One promising approach to maintain cognitive health is to improve sleep quantity and quality. Objective To determine feasibility, ac...

Rural communities are unique and integral to the American economy and culture. A common way rural residence is defined relies upon the U.S. Census Bureau’s definition of rural communities as nonurban communities, in particular those having fewer than 2,500 residents. Certain characteristics of rural living can influence the health and social well-b...

Background Self-efficacy, or the perceived capability to engage in a behavior, has been shown to play an important role in adhering to weight loss treatment. Given that adherence is extremely important for successful weight loss outcomes and that sleep and self-efficacy are modifiable factors in this relationship, we examined the association betwee...

Mild cognitive impairment (MCI) impacts approximately 20% of older adults, with many also experiencing sleep disorders, such as insomnia. Given the relationship between sleep and dementia, addressing sleep issues may offer an opportunity to treat reversible causes. There are two primary treatments for insomnia: behavioral-based (cognitive behaviora...

The 2011 Annual Wellness Visit (AWV) Medicare benefit includes a cognitive screening component intended to improve screening of older adults. However, available literature only presents physician perspectives on cognitive screening prior to 2011. The purpose of this study was to explore primary care provider (PCP) attitudes and perceptions of cogni...

Internet-based interventions using technology can promote access to treatment and reduce participant burden for sleep disorders. However, preliminary studies examining technology use and compliance in older adults with mild cognitive impairment (MCI) are needed prior to undertaking large-scale interventions. Older adults with MCI were recruited fro...

Background Individuals with mild cognitive impairment (MCI) experience more sleep disturbances than individuals without MCI, and improving sleep in this at‐risk group may delay progression to Alzheimer’s disease. Internet‐based interventions may promote access to treatments for sleep disorders, such as insomnia. However, preliminary studies examini...

Insomnia is a common disorder that affects up to 40% of people age 65 and older. Untreated insomnia can decrease quality of life, increase healthcare use, and exacerbate cognitive problems. Individuals with cognitive impairment experience more sleep disorders than those without cognitive concerns, yet little is known about insomnia and mild cogniti...

New advances in digital technologies and data-collection methods support expansion of the traditional research model in the current Digital Age. As researchers continue to explore ways to collect, manage, and share individual-level research study data, investigators must also acknowledge new ethical considerations that arise. To ensure protection o...

As calls for transparency in human subjects research grow, investigators conducting Alzheimer’s disease (AD) biomarker research are increasingly required to consider their ethical obligations regarding the return of AD biomarker test results to research participants. When disclosing these test results to potentially vulnerable participants, investi...

At diagnosis, persons with mild cognitive impairment (PwMCI) and their care partners can receive information that can lead individuals to over or underestimate the significance of MCI as a potential precursor to dementia. Understanding how PwMCI and their care partners perceive the illness can help guide these challenging discussions. The purpose o...

Background: The obesity epidemic is a global concern. Standard behavioral treatment including increased physical activity, reduced energy intake, and behavioral change counseling is an effective lifestyle intervention for weight loss. Purpose: To identify distinct step count patterns among weight loss intervention participants, examine weight lo...

Misdiagnosis, lack of specialists, and patient dismissal of symptoms can contribute to delayed detection of early cognitive impairment. Understanding patient perspectives during and around time of cognitive diagnosis is crucial, as reactions to diagnosis can impact disease management and overall health. The current study conducted semi-structured i...

Introduction Given mounting calls to disclose biomarker test results to research participants, we explored factors underlying decisions by patients with mild cognitive impairment to receive amyloid imaging results. Methods Prospective, qualitative interviews were conducted with 59 participants (30 = mild cognitive impairment patients, 29 = care pa...

Aims Women with recurrent ovarian cancer (OC) experience a wide range of cancer- and treatment-related symptoms that negatively impact their quality of life (QOL). Research demonstrates that geographic differences in access to high-quality care are associated with healthcare disparities. Our objectives were to evaluate whether rural (versus urban)...

Background: The proliferation of biomarker testing in Alzheimer’s disease (AD) research has spurred questions about the clinical and/or personal utility of such tests. We explored how patients with mild cognitive impairment (MCI) and their family care partners view the potential personal utility of PET amyloid imaging (AI). Methods Participants inc...

e18083 Background: Women with recurrent ovarian cancer (OC) experience a wide range of cancer- and treatment-related symptoms that negatively impact quality of life (QOL). Studies have reported healthcare disparities by geographic residence related to distance, time, and financial barriers to accessing high quality care. However, no studies have ev...

Limited access to resources and delayed detection of subtle cognitive changes may negatively impact the long-term cognitive health of rural-dwelling adults. This study explored perceived social determinants of health among older, rural-dwelling adults with early-stage cognitive impairment. Semi-structured interviews were conducted with older, rural...

Background: Currently, 82.1% of African-American (AA) women are overweight or obese, and 48.9% of AA women have cardiovascular disease (CVD), the leading cause of death. Binge eating disorder (BED) is associated with severe obesity, psychiatric morbidity, and increased risk for CVD. Among AA women, BED is the most common eating disorder and has a 3...

Purpose: Mild cognitive impairment (MCI) is a well-recognized risk state for Alzheimer's disease and other dementias. MCI is rapidly increasing among older adults in general and has not yet been examined in older adults within the Appalachian region. Our objective was to compare MCI symptom severity among older rural and urban Appalachian adults w...

Background Older adults are especially susceptible to adverse consequences of potentially inappropriate medications (PIMs), such as benzodiazepine receptor agonists (BZDRAs), due to age-related pharmacokinetic and pharmacodynamic changes. Although some risk factors for BZDRA use in older adults have been identified, the role of rural versus urban r...

Introduction: Increased physical activity (PA) along with reduced energy intake are the key components of weight loss treatment. Objective measures of PA are more reliable than self-report and are infrequently used in clinical trials. Pedometers are inexpensive, often imbedded in mobile devices (e.g. smartphones), and provide a good estimate of ove...

Introduction: Our recent work demonstrated that obese/overweight individuals exhibit different patterns of self-weighing behavior over time. To identify possible contributors to varying patterns, we examined the differences in changes in self-efficacy (SE) by self-weighing pattern groups. Hypothesis: Higher self-weighing group would have greater in...

Introduction: Neighborhood factors may play an important role in the treatment of obesity. However, it is unclear if exposures to certain neighborhood factors influence self-efficacy among individuals attempting to lose weight. Hypothesis: We hypothesized that individuals living in obesogenic neighborhood environments at baseline would have low sel...

Preventing attrition is a major concern in behavioral weight loss intervention studies. The purpose of this analysis was to identify baseline and six-month predictors associated with participant attrition across three independent clinical trials of behavioral weight loss interventions (PREFER, SELF, and SMART) that were conducted over 10years. Base...

Preparing nurses to care for a growing population of older adults is one of the most significant challenges for nursing education. The purpose of the current study was to describe baccalaureate nursing students’ knowledge of and attitudes toward older adults, and explore the impact of a gerontological nursing course on their knowledge and attitudes...

Introduction: Obesity research has typically focused on the overall weight change pattern in randomized clinical trials (RCTs), ignoring the clustering of individuals with distinct weight change patterns (e.g., continuing to lose, maintain weight loss, or regain weight). The study aim was to identify trajectories of weight change and their associat...

Background: Obesity is a known risk factor for coronary heart disease (CHD) and plays a role in other CHD risk factors including dyslipidemia, hypertension, and type 2 diabetes mellitus. With nearly two-thirds of the adult US population being overweight and obese, it is important to know how these individuals perceive their CHD risk. Objective: The...

Evidence supports the role of feedback in reinforcing motivation for behavior change. Feedback that provides reinforcement has the potential to increase dietary self-monitoring and enhance attainment of recommended dietary intake. The aim of this study was to examine the impact of daily feedback (DFB) messages, delivered remotely, on changes in die...

Purpose: The proportion of people over 65 years of age is higher in rural areas than in urban areas, and their numbers are expected to increase in the next decade. This study used Andersen's behavioral model to examine quality of life (QOL) in a nationally representative sample of community-dwelling adults 65 years and older according to geographic...

According to the World Health Organization, quality of life (QOL) includes physical and mental health, emotional well-being, and social functioning. Using an adaptation of Andersen's behavioral model, we examined the associations between the three dimensions of QOL and needs and health behaviors in a nationally representative sample of adults 65 ye...